Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait

Karen C Schliep; Emily M Mitchell; Sunni L Mumford; Rose G Radin; Shvetha M Zarek; Lindsey Sjaarda; Enrique F Schisterman

doi:10.1097/aog.0000000000001159

Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait

Schliep KC, Mitchell EM, Mumford SL, Radin RG, Zarek SM, Sjaarda L, Schisterman EF

Published February 2016 Obstetrics & Gynecology, 127(2), 204-212

DOI 10.1097/aog.0000000000001159 PMID 26942344 PMC PMC4780347

RRM Academy Synopsis

Women with early loss who tried within 3 months had more live births

A secondary analysis of a randomized trial in 1,083 women with one or two prior early losses found that women who tried within 3 months of the loss had more live births: about 5 out of 10 against about 4 out of 10. They also had a shorter time to pregnancy.

Key Findings

Live birth occurred in 53.2% of women who began trying within 0 to 3 months of the loss (n=765) and in 36.1% of women who began after more than 3 months (n=233).
The 0 to 3 month interval had an adjusted fecundability odds ratio of 1.71 (95% CI: 1.30, 2.25) for time to pregnancy leading to a live birth.
Median time to pregnancy leading to a live birth was 5 cycles (IQR 3, 8) with a 0 to 3 month interval and 6 cycles (IQR 4, 9) with a longer one.
Clinical loss occurred in 11.5% of the 0 to 3 month group and 10.7% of the longer-interval group (P=0.74); preterm birth, preeclampsia and gestational diabetes showed no significant increase.
Compared with an interval of >3–6 months, an interval of >12 months had an adjusted fecundability odds ratio of 0.60 (95% CI: 0.38, 0.95).

Interpretation

This cohort study is a secondary analysis of a randomized aspirin trial, following 1,083 women aged 18 to 40 with one or two prior early losses, regular cycles and no known history of infertility through up to six cycles of trying and through delivery of any pregnancy. The authors note that the start of trying was self-reported. The findings support larger studies of how soon to try again after an early loss.

RRM Context

Restorative reproductive medicine centers on the couple's cycle and on finding the cause of each loss. The trial's participants had regular menstrual cycles and no known history of infertility, and the paper counts time to pregnancy in menstrual cycles. Cycle charting records those cycles directly, so a chart shows when attempts began and how many cycles passed before conception.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To compare time to pregnancy and live birth among couples with varying intervals of pregnancy loss date to subsequent trying to conceive date.

Methods

In this secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial, 1,083 women aged 18-40 years with one to two prior early losses and whose last pregnancy outcome was a nonectopic or nonmolar loss were included. Participants were actively followed for up to six menstrual cycles and, for women achieving pregnancy, until pregnancy outcome. We calculated intervals as start of trying to conceive date minus pregnancy loss date. Time to pregnancy was defined as start of trying to conceive until subsequent conception. Discrete Cox models, accounting for left truncation and right censoring, estimated fecundability odds ratios (ORs) adjusting for age, race, body mass index, education, and subfertility. Although intervals were assessed prior to randomization and thus reasoned to have no relation with treatment assignment, additional adjustment for treatment was evaluated given that low-dose aspirin was previously shown to be predictive of time to pregnancy.

Results

Couples with a 0-3-month interval (n=765 [76.7%]) compared with a greater than 3-month (n=233 [23.4%]) interval were more likely to achieve live birth (53.2% compared with 36.1%) with a significantly shorter time to pregnancy leading to live birth (median [interquartile range] five cycles [three, eight], adjusted fecundability OR 1.71 [95% confidence interval 1.30-2.25]). Additionally adjusting for low-dose aspirin treatment did not appreciably alter estimates.

Conclusion

Our study supports the hypothesis that there is no physiologic evidence for delaying pregnancy attempt after an early loss.

Karen C Schliep, Emily M Mitchell, Sunni L Mumford, Rose G Radin, Shvetha M Zarek, Lindsey Sjaarda, Enrique F Schisterman

K Schliep, E Mitchell, S Mumford, R Radin, S Zarek, L Sjaarda, E Schisterman

PMID 26942344 26942344 DOI 10.1097/aog.0000000000001159 10.1097/aog.0000000000001159 Schliep et al. 2016, Schliep 2016

Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait

Women with early loss who tried within 3 months had more live births

Key Findings

Interpretation

RRM Context

Abstract

By this author

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