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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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