Timing of Pregnancy After Curettage
It is generally recommended to wait at least 1-3 months after a curettage (dilation and curettage) procedure before attempting pregnancy to allow for complete endometrial healing and recovery.
Recommendations Based on Type of Curettage
After Miscarriage/Incomplete Abortion
- While some evidence suggests conception can occur successfully as early as 3 weeks after curettage 1, optimal endometrial recovery typically takes 1-3 months
- Research indicates that waiting at least 1 month allows for:
- Complete endometrial healing
- Restoration of normal menstrual cycle
- Emotional recovery from pregnancy loss
After Molar Pregnancy
- Much longer waiting period required
- Wait at least 6 months after hCG normalization (defined as 3 consecutive normal assays) 2
- Complete monitoring protocol includes two additional measurements at 3-month intervals after normalization 2
- Reliable contraception should be used during the entire monitoring period
After Bariatric Surgery
- If curettage was performed in a patient with history of bariatric surgery, additional waiting time is recommended
- Wait until a stable weight is achieved, typically:
- 1 year after sleeve gastrectomy or Roux-en-Y gastric bypass
- 2 years after adjustable gastric banding 3
Evidence for Waiting Period
Endometrial Recovery
- Research shows that D&C can cause transient decrease in reproductive function 4
- Study of frozen embryo transfers showed:
- Significantly reduced endometrial thickness within 6 months after D&C
- Higher live birth rates and lower pregnancy loss when waiting >6 months after D&C 4
Fertility Outcomes
- Comparative studies show no significant difference in conception rates between curettage (92%) and expectant management (96%) groups 5
- However, ongoing pregnancy rates were slightly higher in the curettage group (87% vs 78%) 5
Special Considerations
After Liver Transplantation
- If curettage was performed in a liver transplant recipient, pregnancy should be postponed for at least 1 year after transplantation 3
- Stable graft function, stable immunosuppression, and no hypertension are important factors for good pregnancy outcomes 3
After Cesarean Scar Pregnancy Treatment
- If curettage was performed for cesarean scar pregnancy after uterine artery embolization, additional healing time may be needed 6
- Consider hysteroscopic evaluation before attempting pregnancy to check for diverticulum in the lower uterine segment 6
Recommendations for Preconception Care
- Complete a full menstrual cycle before attempting pregnancy
- Begin prenatal vitamins and folic acid supplementation
- Ensure any underlying conditions that led to the need for curettage are addressed
- Consider preconception counseling, especially if curettage was performed for pregnancy complications
Common Pitfalls to Avoid
- Attempting pregnancy too soon: May increase risk of endometrial insufficiency and potential pregnancy complications
- Waiting unnecessarily long: For uncomplicated D&C procedures, extended waiting beyond 3 months provides no additional benefit
- Ignoring emotional recovery: Psychological readiness is as important as physical recovery
In summary, while some women may successfully conceive shortly after curettage, the evidence supports waiting at least 1-3 months after an uncomplicated procedure to optimize endometrial healing and pregnancy outcomes. For molar pregnancies, a minimum 6-month waiting period after hCG normalization is essential.