Can you get pregnant after a dilation and curettage (D&C)?

Can You Get Pregnant After a D&C?

Yes, you can get pregnant after a dilation and curettage (D&C), but optimal fertility recovery requires waiting approximately 6 months before attempting conception to maximize live birth rates and minimize pregnancy loss risk. 1

Immediate Fertility Considerations

• Pregnancy is possible immediately after D&C, even when fertility preservation was not the primary goal 2
• Women should receive contraception counseling before and after the procedure, as fertility can return quickly 3
• A negative pregnancy test must be confirmed before any subsequent D&C procedures 2

Optimal Timing for Conception After D&C

Six-Month Recovery Period

• Waiting more than 6 months after D&C significantly improves reproductive outcomes in frozen embryo transfer cycles, with a 1.65-fold higher relative risk for live birth compared to attempting pregnancy within 6 months 1
• The endometrium requires this recovery period to restore normal reproductive function, though endometrial thickness measurements may not fully reflect functional recovery 1
• Pregnancy loss risk is lower (0.62 relative risk) when conception occurs after the 6-month recovery period 1

Risks of Early Conception

• D&C increases the risk of preterm birth in subsequent pregnancies, with an odds ratio of 1.29 for birth before 37 weeks compared to women without D&C history 4
• The risk is dose-dependent: multiple D&C procedures increase preterm birth risk further (OR 1.74) 4
• Very preterm birth risk is substantially elevated, with odds ratios of 1.69 for birth before 32 weeks and 1.68 for birth before 28 weeks 4
• Spontaneous preterm birth specifically shows an odds ratio of 1.44 after D&C 4

Long-Term Fertility Outcomes

Intrauterine Adhesion Risk

• Intrauterine adhesions (IUAs) develop in 22.4% of women after D&C, which can impair future fertility 5
• Hysteroscopic resection results in fewer adhesions (13%) compared to traditional D&C (30%) when managing retained products of conception 5
• Incomplete evacuation occurs in 29% of D&C cases versus only 1% with hysteroscopic approaches 5

Successful Pregnancy Rates

• Despite these risks, conception, ongoing pregnancy, and live birth rates remain similar between D&C and alternative management approaches in most studies 5
• In cesarean scar pregnancy cases treated with uterine artery embolization followed by D&C, 43.8% of women desiring pregnancy achieved successful delivery 6

Special Clinical Contexts

Fertility-Sparing Therapy for Endometrial Disease

• For women with stage IA endometrioid adenocarcinoma who desire fertility preservation, close monitoring with endometrial sampling (biopsies or D&C) every 3-6 months is required during progestin-based therapy 2
• Approximately 35% of young women achieve pregnancy after hormonal therapy with subsequent negative biopsies, though recurrence rates are also 35% 2
• Total hysterectomy with bilateral salpingo-oophorectomy is recommended after childbearing is complete or if therapy fails 2

Contraception Recommendations

• Long-acting reversible contraception (LARC) methods are preferred postpartum, including IUDs and implants 3
• Copper IUDs can be inserted immediately after delivery (Category 1 for breastfeeding women) 3
• Hormonal IUDs show higher 6-month continuation rates with immediate placement (80%) versus interval placement (50%), despite higher expulsion rates 3

Clinical Algorithm for Post-D&C Pregnancy Planning

1. Confirm complete evacuation and resolution of any complications
2. Wait minimum 6 months before attempting conception to optimize outcomes 1
3. Evaluate for intrauterine adhesions if menstrual patterns change or fertility concerns arise 5
4. Counsel about increased preterm birth risk (29% increase) in subsequent pregnancy 4
5. Consider hysteroscopic evaluation if multiple D&C procedures were performed or if conception difficulties occur 5
6. Implement appropriate contraception during the recovery period using LARC methods 3

Critical Pitfalls to Avoid

• Do not assume infertility after D&C—unintended pregnancy can occur before optimal recovery 2, 3
• Do not rely solely on endometrial thickness to assess readiness for conception, as functional recovery may lag behind structural measurements 1
• Do not dismiss the cumulative risk of multiple D&C procedures, which substantially increases preterm birth risk 4
• Do not overlook the need for close monitoring in women with endometrial disease who choose fertility-sparing approaches 2