There are two types of infertility. Primary and secondary.

Primary infertility is the medical condition when the couple has no pregnancy after having regular  unprotected sex for at least one year ( for the couples women are older than 35 year old this duration is for 6 months).

Secondary infertility means unability to become pregnant after previous pregnancy ; even the previous pregnancy results in childbirth or not .   

If a couple has experienced miscarriage what should be the next step and how fertility should be assessed after miscarriage ?

The first three months of pregnancy is named as first trimester and we mostly see miscarriages in the first trimester. Most of the pregnancy losses are idiopathic ; means no obvious reason. Main reason of early pregnancy loss is releated to embryo such as genetic problems. Most of the couples can have healthy pregnancies after miscarriages. Repeated miscarriages ( it means more then three consecutive miscarriages) are releated to a medical problems ( genetic problems with couple such as translocation carriers etc, some blood clotting problems such as maternal trombophilia, hormonal problems such as maternal thyroid issues, some maternal autoimmun diseases, maternal  immun disorders, infections, uterin malformations such as fibroid or uterin subseptus etc..)

Fertility after miscarriage depends on maternal age, the spesific reason of miscarriage and the duration of infertility. With advanced age and a known problem the couple should have a fertility consultation to plan the treatment protocol.

After a miscarriage timing for fertility treatment is determined according to medical conditions. If the lost pregnancy is clinical means visible pregnancy sac or fetus in ultrasound scan it is better to wait at least for two spontenous cycle for uterin rest before having any embryo transfer. But it is still possible to have egg collection, creating the embryos and freezing them for future to transfer.

Fertility after birth is also depend mainly on the age of women due to ovarian reserve and egg quality. Of course if the couple had their pregnancy and birth with the help of assisted reproductictive techniques it is more important to have fertility counseling. The uterin rest time should be at least for 6 months after a vaginal delivery whilst this time is for 12 months after a ceserean section delivery. If waiting for this time frame is too long because of age and concerns about waiting the egg collection and freezing the embryos will be the best option for the fertility rate. During treatment the fertility injections will pass into milk stream that’s why breastfeeding is not recommended during ovarian stimulation.

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