Can experiencing a miscarriage lead to infertility issues?

Question

Hello doctor,

Can a miscarriage cause infertility problems? I had a miscarriage two years back. I was given Iron supplements to take for a month. I was given Gulf Ferrous Sulphate compound tablets and Gulf Folic Acid 5 mg. I stopped taking them because they were making me sick. I felt like I was gonna pass out when I took them. I felt bloated and constipated. So I went to the pharmacy to buy my Iron supplements. I bought Ferofol 24 mg. Used it for about four months, and then I started feeling sick, feeling weak, nausea, leg pains, chest pains, feeling out of breath and had constant headaches. Woke up one day with severe chest pain, went to the hospital. I was diagnosed with iron deficiency anemia. I was put on a six months treatment. The doctor said I must not fall pregnant until I finish my treatment. I was also given contraceptives but I never used them. The doctor said the Iron supplements I was using had a small dose for someone who has anemia. Hence, my Iron levels dropped whilst taking them. I have been trying for a baby for the past few months. We have been using cycle tracker to track my most fertile days. But we do not seem to be winning. I have been having irregular periods.

Two weeks before my periods, I was feeling pregnancy symptoms. I was feeling tired, had constant headaches, felt nausea, and lightheadedness. I thought either my iron levels were low or I was pregnant. Went to see a GP, took a pregnancy test that came out negative, but my pressure was high. Later, I had light red spotting for two days, then on the second, it appeared to be a normal period. Four days into my period,I passed out a big clot like a product. Before that, I had severe cramps similar to the ones I had when I had a miscarriage. It felt like something was tearing inside, pressing against my uterus, also had back pain. After I passed out a clot, we saw a gynecologist. He said it is normal for blood to clot especially if it was late for a couple of days. I had an ultrasound, the gynecologist said everything was fine except my left vein was a bit swollen. He asked if I was peeing more than usual. I said yes and that I had difficulties sleeping on my sides and that my urine had bubbles and it was bright yellow. He said it could be a kidney infection. They gave me antibiotics and a drip. I have not got my period yet for this month. I do not know when it is going come. Am I not ovulating? Can a miscarriage cause infertility problems or is it the Iron supplements I am taking? I want to have a baby. What could be causing my period delays?

Answer 1

Hi,

Welcome to icliniq.com.

Miscarriage is not a usual reason for infertility, but anemia is definitely a cause. From your history I presume that the bleeding of periods is quite heavy, that could be the reason for anemia. If blood smear shows an iron deficiency anemia and you are feeling weakness with gastritis, you need to know the severity of anemia, by doing a Hb % and PCV (packed cell volume). If Hb is less than 8 g/dl, then it is better to have an iron sucrose infusion, based on the calculation. If anemia is severe, your gut wall will be edematous and iron absorption from tablets will be poor. In anemia, you will have anovulatory cycles (when you are anemic body will conserve energy and hormonal balance is lost, it will save blood by delaying periods). So, that is the reason for irregular periods, when the delay of periods occur, the inner lining of the uterus thickens and as it drops out, the pain due to dilatation of cervix will occur. Pain will be relieved as soon as the clot or the mass falls out.

As long as you have anovulatory cycles, to maintain a good Hb, you will need Iron tablets, Vitamin B complex, proteins, these three components are ingredients of hemoglobin. So to have a good fertility outcome, have anemia workup done and get it fully corrected with parenteral treatment. Kindly see if the following checklist of investigations is done:

1. Husband- Semen analysis at least two, done four weeks apart preferably in an infertility center (examination done by andrologist), blood sugars.

2. Wife- Blood sugars, thyroid profile. Ultrasound scans to evaluate uterus, ovaries, and adnexa. Confirm tubal patency, most important as tube is the connection between uterus and ovaries (the bridge where sperm meets the egg and forms a baby). This is in the size of hair follicle and cannot be seen on scans. Being such a small opening, the tube can get blocked easily. So, check with HSG (X-ray with dye), or SSG (scan with dye) or laparoscopy. If all this is done and found normal, nothing can stop a pregnancy with God's will.

All the best.