Miscarriage after IVF – how to reduce the risk

Miscarriage after IVF can happen. In fact, it’s as common as miscarriage in non-assisted pregnancies. And since older women often attempt IVF, miscarriages can sadly let them down. At aged 30, one in five pregnancies ends in miscarriage. At aged 42, it’s one in two.

That’s the depressing bit. Now the good news. There are ways IVF patients can reduce the risk of miscarriage after their treatment. You may know some of them already. Your clinic might share others with you. But do you know the full picture? Based on research, and experience with our own patients, these are our top 10 tips for lowering your chances of miscarriage after IVF.

1. Check your TSH.

As an IVF patient, your clinic should give you a full blood hormone profile well before treatment. But clinics frequently miss out the TSH test, opting for just FSH, LH and perhaps AMH if you’re lucky. Yet there’s a link between abnormal TSH levels and miscarriage, not to mention other conception problems. Medication can guard against thyroid problems. So take the test: TSH problems are treatable. Read our post on TSH for more information.

2. Have a hysteroscopy.

Another alarmingly overlooked pre-IVF procedure is the humble hysteroscopy. It’s not always suggested by doctors and clinics, who prefer to wait till miscarriages become recurrent. Not good enough. Growths, blockages and damage to the uterus are surprisingly common. You’re paying for your IVF treatment and want success first time round. A hysteroscopy is better than an HSG or an ultrasound scan at spotting uterine problems – and it can rectify them too. Uterine issues could be a barrier to conception, and a cause of miscarriage after an IVF pregnancy.

3. Pick the right progesterone.

After your IVF cycle, whether it’s with your own eggs or donated ones, you’ll be given progesterone to maintain your pregnancy. These are available as pills (Utrogestan, Prometrium), pessaries (Cyclogest), gel (Crinone) or injections (Gestone, Agolutin). Many of our patients take Utrogestan orally. But they can sometimes work better when taken vaginally because they’re arguably absorbed better. As for intra-muscular injections, they’re the gold standard for progesterone support, but fiddly to do. You either have to get your partner to administer them or take a daily trip to your local nurse.

Crucially, Cyclogest, vaginally-taken Utrogestan and Gestone guard against a common side effect of the medication: nausea. This can cause vomiting, perhaps affecting your progesterone intake and inadvertently causing miscarriage. But nausea isn’t a threat if you take your progesterone vaginally or by injection.

4. Get in shape before your IVF.

A miscarriage after IVF, or a non-assisted pregnancy, often has no discernible cause. The dreaded word ‘unexplained’ is often used. But that doesn’t mean being healthy isn’t important. At least three months before your treatment, start a health regime. Don’t go mad; but be sensible. Stop smoking – a known cause of miscarriage. Stop drinking alcohol, and definitely avoid non-prescription drugs. Get your BMI in-range and eat a balanced diet, including plenty of fruit and vegetables. Once you’re pregnant, avoid night shifts and heavy lifting. It could make all the difference.

5. Love your blood.

Thick or clotting blood can be a miscarriage threat because blood flow to the foetus could be affected. As an IVF patient, get tested for identifiable blood disorders before your treatment. Hughes syndrome (also know as antiphospholipid syndrome, APS or sticky blood) can be treated with blood thinners like Clexane and low-dose aspirin. Auto-immune disorders, thyroid problems, thrombophilia and natural killer (NK) cells can be identified in a blood test. Insist on a screen for all of them. Medication can help if there’s a problem – acting as a barrier to potential miscarriage.

6. Are your cells Natural Born Killers?

As outlined above, natural killer (NK) cells are in the blood. But they’re not nearly as scary as fertility clinics want you to believe. NK cells exist in our bodies to fight off infection. There’s a theory that elevated NK numbers in the uterine lining can actually attack the baby. It’s quite possibly nonsense – and it certainly hasn’t been proved. Prednisone, a steroid, is sometimes prescribed as immune therapy to suppress NK cells allegedly on the loose. Intralipid drugs are occasionally suggested. And some clinics even offer uterine biopsies, since NK activity in the womb can’t be seen in a blood test.

Be sceptical. Research into NK cells, and any link to miscarriage, is currently inconclusive. So don’t pay for expensive NK tests unless you’re sure they will make a difference to your IVF outcome. Which you can’t be. So don’t pay.

7. Keep medicated – and know when to stop.

Many IVF patients find it hard to remember to take their medication. But it’s vital you do, because a miscarriage is technically possible after just one missed dose. It’s after transfer that complacency really kicks in. Have your medication in your bag and on the kitchen table. And set the alarm on your mobile device.

A typical post-IVF medication regime will be estrogens and gestagens (progesterone). But you could be put on Prednisone, baby aspirin and Clexane. Take all of them religiously at the same time each day. In terms of reducing your medication, get clear guidance from your clinic. You’ll probably be weaned off your drugs by the time you’re 12 weeks pregnant, but every patient protocol is different. So check, check and check again.

8. Save your cervix.

After the rollercoaster of IVF and a much-hoped-for pregnancy, the last thing you want is for your cervix to stop playing ball. A weak, or incompetent, cervix should be anticipated before your IVF cycle. Then a cervical stitch can be scheduled during early pregnancy to try and stop your cervix opening and potentially initiating a miscarriage.

You can reduce the chances of this type of miscarriage if you and your doctor are prepared. If you’ve had surgery on your cervix, damaged it in a previous difficult birth or termination, or have an abnormally shaped womb, these are warning signs. If you’ve suffered a late miscarriage or premature birth, be ready too.

9. Beware infections.

Infections can cause miscarriage, so be aware of them before and after your IVF cycle. Get tested for STDs, obviously. Toxoplasmosis, catchable from unwashed vegetables and cat faeces, can trigger miscarriage – so don’t touch the cat and wash your fruit and veg thoroughly. Listeria and general infections can also cause miscarriage, as can rubella: check you had the MMR jab or the single injection. If you have uncontrolled diabetes (okay, not an infection), this can cause miscarriage too. So take a diabetes blood test before your planned IVF cycle.

10. Over 42? Go for donor eggs.

A dose of realism is needed when you’re 42. Miscarriage rates are 50 per cent. Live-birth rates for IVF with your own eggs are only 10 to 15 per cent. And the likelihood of chromosomal abnormalities are higher than average. Donor eggs take on all three. If your objective is a baby, and reduced heartache, donor eggs or donor embryos are a consideration. It’s hard to bid farewell to your own eggs. But we eventually chose donated eggs and succeeded. Our wonderful little Ida arrived nine months later.

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