Trying again after miscarriage

Most women who miscarry can conceive in the future and will carry that pregnancy to term. Even though pregnancy loss can take a heavy emotional toll on you, it's important to remember that. So, we'll say it again. Most women who miscarry can conceive in the future and will carry that pregnancy to term.

That being the case, if you've had only one pregnancy loss, then your best bet is to try again. It makes sense that you need to be happy and healthy if you are trying to get pregnant.

Experts in fertility management say that you should aim to be in peak health for a good 4 months before conceiving. Here are some guidelines for keeping yourself in shape for pregnancy.

1. Relax

The role of stress and psychological barriers is variously played up and down according to whom you speak. Whether or not it does affect pregnancy outcome, it will certainly improve how you feel in the meantime. And, it's always a good idea to reduce the stress in your life.

2. Maintain a sensible diet

Try to have a healthy balanced diet, with plenty of fruits, vegetables and cereals. If you decide to supplement your diet with multivitamins, make sure that they are safe to take in early pregnancy and that they do not exceed the recommended daily limits. Check with your pharmacist if you are unsure. We do recommend that you take folic acid to minimise the risk of spina bifida (a birth defect) and also to overcome some rare causes of pregnancy loss. You should take at least 500 micrograms a day from the time you start trying to get pregnant until you are at least 3 months pregnant.

3. Infection control

Some infections that could affect pregnancy can be present in foods (eg. Listeria and Salmonella).

Some precautions that you can take are to:

• ensure that all meat, eggs and fish are well cooked, and avoid pâté and products containing raw eggs (eg. mayonnaise) unless pasteurized,
• ensure milk and soft cheeses are pasteurized,
• wash fruit and salad vegetables before you eat them, and
• make sure re-heated foods are heated through properly.

Toxoplasmosis is an infection that can be carried by cats or in the soil. Wear gloves when gardening or, if you have cats, when emptying their litter tray. Wash your hands thoroughly before eating if you have been handling a cat. (If you are pregnant it's better to read books about cats rather than to handle them excessively!)

Make sure you are immune to German measles (rubella) before you get pregnant.

4. Exercise

It is a good idea to have a regular exercise regimen to maintain general health and well-being. In particular, exercises that strengthen the back, buttocks, abdominal and pelvic floor muscles are recommended. Generally, you can continue with your normal exercise unless it causes you discomfort or your doctor advises against it. Never persist with exercise if you have a discharge from the vagina in pregnancy or if you have back pain: these are danger signs of cervical incompetence and you should see your obstetrician immediately.

5. Drugs

• Alcohol : It is not known what amount of alcohol if any is safe in pregnancy, so you should avoid it completely, but a small amount (1-2 glasses of wine a day) is allowable while you are attempting to conceive.
• Smoking : Cigarette smoking has been shown to affect the quality of sperm and eggs, and is poisonous to very early embryos. While this might not be critical when reproduction is normal, it can certainly be an important cause of harm when embryos are stressed, as in IVF procedures, and during pregnancy. We strongly recommend that you stop smoking altogether, or failing that, don't smoke during your treatment or pregnancy.
• Caffeine : Caffeine is found in tea, coffee and cola. There are a few studies that suggest that caffeine can have an adverse effect on fertility, so you should moderate your intake.
• Social drugs : Social drugs should not be taken at all in pregnancy. Your baby can develop a dependency and will then have to withdraw from the drug after birth - a process that can take several weeks and this is hardly a fair start to life.
• Medications: Paracetamol (e.g. Panadol) in the usual doses is safe to take for pain while pregnant. If you are taking any medication tell your doctor that you are planning a pregnancy and that you want his or her advice on the safety of your current medications for both you and the baby. If in doubt about anything, check with your doctor or pharmacist. Some vaccinations are safe, but others (such as rubella) need to be given well before you conceive.
• Herbs: Safety data, during infertility treatment, pregnancy and lactation are still largely lacking for many herbal medications, and recommendations for usage and dosage vary greatly from brand to brand, and clinician to clinician. Talk to your doctor and herbalist about the specific safety of particular preparations in pregnancy. Preparations suspected of being harmful include St John's wort and composite root extract (and any herbal medications used to promote uterine contractions).