Miscarriage after IVF – how to reduce the risk
Miscarriage after IVF can happen. In fact, it’s as common as miscarriage in natural 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. IVF patients can reduce their miscarriage risk. Based on research, and the experience of our own patients, read our 10 tips for lowering your chances of miscarriage after IVF.
1. Check your TSH.
As an IVF patient, you should have a full blood hormone profile test before treatment. But clinics frequently miss out the TSH test, opting for ovarian checks (FSH, LH and AMH) only. There’s a link between abnormal TSH levels and miscarriage. Medication, started at least a month before egg retrieval, can correct abnormal thyroid levels.
Having donor eggs, donor embryos of an FET? It’s worth checking your TSH levels before your treatment too. The same miscarriage rules apply.
2. Have a hysteroscopy.
Another overlooked pre-IVF procedure is the humble hysteroscopy. It’s not always suggested by doctors and clinics, who may prefer to wait till miscarriages become recurrent (read this study). Not good enough. Growths, blockages and damage to the uterus are surprisingly common. You may have had past miscarriages due to these anomalies without even knowing it.
You’re paying for your IVF treatment and want success first time round. A hysteroscopy is better than an ultrasound scan at spotting uterine problems – and it can rectify them too. No need to pay privately: most countries with public healthcare will give you a hysteroscopy for free.
3. Pick the right progesterone.
In an IVF, donor or FET cycle, you’ll take progesterone to maintain your pregnancy. These are available as pills, pessaries, gel or injections. Vaginal Utrogestan is super-effective and the easiest format to adjust if you experience post-transfer bleeding. These, and intramuscular injections, may be the best progesterone formats to guard against miscarriage.
Don’t discount Crinone though. A 2019 study found that it reduced early miscarriages better than intramuscular injections. Small study though. Other research supports IM injections more.
4. Get in shape before your IVF.
A miscarriage after IVF often has no discernible cause. This doesn’t mean being healthy isn’t important. At least three months before your treatment, both partners should start a health regime. Stop smoking – a known cause of miscarriage. Stop drinking alcohol. Take moderate, not excessive, exercise.
Also, get your BMI in the normal range. Eat a balanced diet, including plenty of fruit and vegetables. A 2018 study found that a Mediterranean diet improved IVF success rates for non-obese women (i.e. fewer miscarriages happened).
By the way, avoid sex after embryo transfer. A 2014 study showed this heightened miscarriage rates.
5. Love your blood.
Thick or clotting blood is a miscarriage threat. 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 and thyroid problems can also be identified beforehand. Add-on medication during your treatment can act as a barrier to the miscarriage and implantation risks associated with these conditions.
6. Are your cells Natural Born Killers?
Natural killer (NK) cells are in the blood. But they’re not as scary as they sound. NK cells fight infection. The theory goes 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 is sometimes prescribed as immune therapy to suppress uterine NK cells. Intralipid infusions are occasionally suggested too. The ultimate objective is to encourage implantation and reduce miscarriage.
Reproductive immunology is a very new science, so be sceptical. Don’t pay for expensive immunology testing unless you’re sure it could make a difference. Which you can’t be. So either don’t pay, or ask your IVF clinic for its opinion.
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: a miscarriage is technically possible after just one missed dose. Keep your medication on you – and on the kitchen table. And set the alarm on your mobile device.
A post-IVF medication regime could include estrogen and progesterone. You could be taking Prednisone, baby aspirin and Clexane too. 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 nine weeks pregnant, but every patient protocol is different. So check, check and check again.
8. Size up your cervix.
The last thing you want is for your cervix to stop playing ball. It’s not that common, but a weak, or incompetent, cervix should be assessed before your IVF cycle. A cervical stitch can be scheduled during early pregnancy to 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.
9. Beware infections.
Infections can cause miscarriage. Be aware of them before and after your IVF cycle. Get tested for STDs, obviously. Toxoplasmosis, catchable from unwashed vegetables and cat faeces, can also 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 as well. Check for diabetes well 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.
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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Kasey
Our second round of IVF it was a success I had a lot of bleeding called the doctor they went and seen the babies heart rate said everything was fine two weeks later the baby had no heart rate and I lost a child is it because I stopped the endometrium too soon was there anything that I could’ve done to prevent it I’m 35 and the cost of IVF is extremely expensive and now I just think my whole world and dream is over
Jai
These suggestions are exactly right and if you have a good RE, they will recommend the right protocol for you. I’m 41, have been ttc for 9 years. Five years ago I took a hold of my life. Left my stressful job, adjusted my diet, did yoga weekly, went for acupuncture regularly, cleaned out all the old relationships in my life and committed to the process physically, emotionally, and financially. So many tears along the way but my SO was in 1000% and we took our egos out of it and even shared our struggles with others. It helped. We didn’t stop our life, we kept going. I even decided to start grad school because didn’t want to let this define me. We got with a great doctor a year ago and now after our 2nd round of a FET and a miscarriage in-btwn, we are 9 wks with twins. Whatever happens, we will make it. I have hope. Good luck and don’t give up. You’re stronger than you think. <3
Georgieann
Thanks for sharing. Really encouraging. I pray the twins are growing healthier and strong. Good luck on your pregnancy.
Jada
Hi Jai, I am so happy for you are pregnant with twins!! What a miracle!! I am going through such a hard time right now after FET and now miscarriage …May you please share with me what did you do after your first try of FET to get pregnant again? I am so heartbroken
Rudeshi
I am 33 yrs old, on 28th Mar 2019 I have undergone through FET with 2 embryos.. Everything tested negative observed before was normal but on 10th Apr 2019 when doc performed Beta HCG blood test it shows negative with .38 mIU/ml… It’s been 4 yrs of marriage without any living issue and any other medical problem… God knows when he will do miracle in our lives… This is so much stressful part in any women’s life in spite of trying hard in every aspects to become mother they failed again with tears n disheartened left only… Pls suggest us, do we go for second cycle..
Neeti
Your are right i am on same stage.first ivf cycle completed.after 15 days took upt and it was negative.i got married 4 years ago.no hopes
Johanna
Hi
I did two fet with 2 embryos each time! And failed. I tried my last embryo without birth control, antibiotics, blood thinners, and it worked. I only used estrogen and progesterone. Probably the medication is not helping.
Rene
Five days after having the transfer … my partner was ask to return for her examination and told that that the transfer was unsuccessful..
Two days later, she suffered heavy haemoraging and was taken to the ANE of our local hospital and was told that she was six weeks pregnant and that she had suffered a miscarriage..
Question …
Is it possible to experience heavy bleeding after such a short transfer period ?
Is it also possible that the transfer occurred when she was already pregnant ?
Prior to the transfer she was advised that the lining of her womb rather enlarged..
Please Advise
Vanessa
Actually, you can absolutely do intermuscular progesterone in oil shots yourself, without a nurse or partner. I did for about nine weeks, and was just discharged successfully to my ob. The technique is slightly different than what my doctors office showed but there are YouTube tutorials. A single woman can successfully go through this treatment without a partner and without daily visits to the doctors office.
Naedee
Where did you give yourself the shots at?
Annie
I did my et on 1st Aug and on 18 th I start blood clotting but still on medication…..I m scared and this is my first ivf …. plz help me
Tamara Clarke
Hi. I had my transfer on August 4th. I got a positive pregnancy test on august 18th and found out on September 8th there was no baby. He just stopped growing. The pregnancy sac was empty. I had my D&C on September 13th. Good luck to you and your baby. This was my first IVF
Monica
I am 33, had my 2nd ivf (1st one failed), got 3 FET. After 2wks my Hcg level showed positive result but on day 19 I had cramps and started bleeding with clots. Took another blood test on day 21, hcg level doubled but Nothing could be seen in the ultrasound. My doctor says I must have miscarried. Waiting for another test after a week. Could I still be pregnant? Please share your views. M so depressed!
Kambria Neal
I got pregnant after an FET, developed a blood clot in my uterus, and had lots of bleeding. I ended up having a miscarriage at 8wks, but not due to the clot. It may be just that if your levels are rising, and the doctor said many women have successful pregnancies after developing a clot.. just breath for now.
d
Hi I’m 34. I had ivf in 2014 resulted in my son this year iv been thru 2 ivf cycles and one natural fet with 3 embyros put back all were grade 2 resulted in a pregnancy bt I miscarried at 4weeks totally devastated but have faith it will work
Suma
I’m 34!!!! My 2nd attempt of Ivf going on. Hope of positive i look forward…
Dawn
I’m 44 and about to go through egg retrieval. Very nervous and concerned about everything but trying to stay positive!!
I do have a cat and I do clean his litter. I’m super concerned now remembering the toxoplasmosis. At what point does it affect the baby? Is is now at the egg forming stages? I go for my ultrasound next Saturday. Had a blood test at my baseline. I don’t think I had anything show up or they would have told me right? I’m going to ask today. Thanks for any insight!
Rosie
Hi I’m 44, last week I found out I was pregnant a little over 4 weeks using ED. On Friday my 2nd beta test dropped from 158 to 98. My dr is hoping it’s a lab error, he said he is still hoping. I’m retesting on Tuesday. I’m heartbroken. I’ve been testing at home and today the line was barely there.
Esther Murag
Hey
Did your pregnancy become viable after the drop of hcg ??
Susanmckay
my daughter has had ivf 2micarriages has nkd and they think now sticky blood can she get pregnant both miscarriage s ended in 6 weeks
Sue. Mum
Maureen Ross-Hamilton
A very interesting reassuring read.
I am 47. 1 round with my eggs failed in UK
Round 2 Greece, egg donation. Just failed gutted.
4 frozen eggs left.
We are not yet finished.
Good luck to all.
Oak
Hello, I’m 42 and was told last week that both HCG tests were positive. I’m 4 weeks and scheduled the ultrasound at week 7. But this morning I had bright red bleeding and an hour later had blood clots. Visited the doctor and she examined the uterus but too early to see sac she only saw active bleeding which she said was concerning. She ordered another HCG to check the levels if they were increasing or decreasing 🙁
This Is our 2nd embryo transfer, our first IVF attempt didn’t pass fertilization. We have two embryos left.
Fingers crossed
Aimee
Donor egg IVF isn’t an absolute guarantee of course. I’ve gone through 4 rounds of it and just miscarried at 8 weeks. And I’m perfectly healthy.
L
Hi Aimee,
I completely agree. I have had 3 transfers of donor eggs. The final round I had an endo scratch and quad therapy which resulted in a pregnancy. However, I have just found out the baby stopped growing at 6 weeks so am due to miscarry. Not looking forward to it one bit. No Frosties left so now go to start the whole process again from scratch. 🙁
L
Pj
43, and just been diagnosed with a blighted ovum/ slash not to sure if it’s eptopic.. Waiting to repeat hcg results, they are hoping they are decreasing.. Meaning nature is looking after things.. Really gutting, 3rd round of ivf.. 1st positive, and bloods going well, until my 5 week early pregnancy scan.. Devastation, didn’t know such s thing exists, for now I have to heal emotionally and physically.. As my belly is still swollen, before we face what’s bext..ED on the cards? Where there is a womb there is a way..x
Castlecooley100
I’m 6 weeks today, 44 using donor eggs. I’m on loads of medication, stomach have is like a blackcurrant. Had my HCG done twice 1 week apart 4,49, week 5 409. Apparently it’s a good sign. I’m nervous. Can’t wait to October when I’ll hopefully be 20 weeks
vida
A very good education. Is well noted as am about to go for 2nd ivf journey.
Thank you