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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