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Infertility/Fertility/HELP! Confused about when I can safely concieve after loss. Will this happen again?

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QUESTION: Hello,
My name is Lori Cohen, I am 32 years old and live in New York City.  I recently lost my first pregnancy. We had been trying for approximately 7 months and I was diagnosed with a blighted ovum at 7.5 weeks. I had a D&C and the procedure went very well and I have had no pain or bleeding what so ever. The cycle we conceived I had basic fertility blood tests done on cycle day 4. My FSH was 8.3 but my estradiol was 100. I did end up ovulating earlier than usual that cycle on day 10-11. My cycles have always been very regular every 28 days. Here are my questions/concerns:
1) I have received different opinions on when it is safe to try and concieve again. I obviously wanted this pregnancy very much and would like to try again as soon as safely possible. One doctor recommended waiting for two full cycles and another told me that as soon as my period returns after the D&C that is safe to try. Is there an increased risk for having another miscarriage if I concieve too quickly after a D&C? How long does it take for the uterine lining to heal enough to support a pregnancy? I have read a few studies on this issue, and most seem to conclude that there is not an increased risk for shorter inter pregnancy intervals after miscarriage.
2) it seems like a lot of women do conceive quickly after a miscarriage and D&C. Is there any truth to the theory that you are more fertile for a few months after?
3) should I be concerned about my high estrogen on cycle day 4? Could that be a reflection of my egg quality and possibly why I had an anembryonic pregnancy? Am i at an increased risk for this to happen again? My OBGYN did not seem concerned but I was frightened by the information I found online.
Thank you so much for your time! I really appreciate any advice you can offer!

ANSWER: Hello Lori from the U.S. (New York),

Let me take your questions in sequence since they are placed so orderly:

1.  Studies show that a woman's fertility is heightened within the first six months after having a miscarriage.  I have had infertility patients who could not get pregnant, then get pregnant but miscarry from fertility treatment then immediately get pregnant naturally the next month.  There is absolutely no reason to wait.  All you need to wait for is for your ovary to begin functioning normally and that can take 4-6 weeks.  As soon as you get your next period, go ahead and start trying again!  There is no increased risk after a D&C.
2.  As mentioned studies have shown that you are more fertile within the first 6 months after a miscarriage.
3.  Your hormone findings are not valid.  Discard and forget them.  Hormone testing needs to be done when they are in the lowest level of the cycle to interpret them.  That means they have to be done on cycle day #2 or 3.  If done at the correct time in the cycle, the estrogen level should be less than 100. An estrogen level of 100 means that the ovary has already started its cycle and therefore, the FSH and LH levels are not at the lowest levels and therefore not valid.  Hormone levels do not say anything about egg quality.  It is a measure of ovarian function.

You can only get the correct answers if you ask it from someone who knows the correct answers.  That is why there are specialists.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate


---------- FOLLOW-UP ----------

QUESTION: It has been 2 weeks since the D&C and my doctor cleared me to have intercourse at my follow up appointment. Do I need to use protection until I get my first period after the D&C? Is it safe to conceive before my first cycle? If the uterine lining has not recovered after the D&C will the body even allow a new pregnancy to take hold? I think I will ovulate sometime this week, between 2-3 weeks post D&C and would like to try to conceive only if it is safe.
Thank you!

Answer
Hello Again,

There is no reason for you to wait any further.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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