Miscarriage After IVF: Causes, Risks & Prevention

After consulting multiple fertility specialists and trying all sorts of conservative treatments, you have now decided to undergo one of the modern Assisted Reproductive Procedures, “In-Vitro Fertilization”. A common doubt that never seems to fade is “What if IVF doesn’t work?” 

Many conceive through IVF, but their pregnancies do not continue to term. A miscarriage is a pregnancy loss that occurs before 20 weeks of gestation and can occur in both natural and IVF pregnancies. While miscarriage after IVF can be devastating for aspiring parents who put all their hope in this treatment, it’s important to know that pregnancy is still possible.

Knowing the causes of IVF miscarriage is often the first step in determining the best treatment plan for your case.

Is Miscarriage Common After IVF?

Miscarriage after IVF is as likely as miscarriage after natural conception. IVF itself is not the reason for your early pregnancy loss. In most cases, the underlying reproductive health issues that end naturally-conceived pregnancies are the very reasons that cause miscarriage after IVF. 

Pregnancy loss can occur due to advanced maternal age, hormonal imbalances, uterine conditions, embryo quality, or pre-existing medical issues. 

Again, just because an IVF cycle resulted in a miscarriage doesn’t mean you can’t conceive. A fertility expert will likely assess your reproductive health or the factors that interfere with pregnancy and plan a more personalized procedure for you.

What Causes Miscarriage After IVF?

Let’s take a look at a few possible reasons for pregnancy loss after a successful IVF.

Chromosomal Abnormalities

Research suggests that 50-60% of pregnancy losses are due to chromosomal defects in the baby. Let’s first understand what a chromosomal abnormality means. An embryo should have 46 chromosomes, 23 inherited from each parent. 

Sometimes, an error occurs during division. As a result, some may inherit extra chromosomes, while others have missing chromosomes, both of which increase the risk of pregnancy loss in the early weeks. Now, this has nothing to do with IVF. Embryos can have chromosomal defects before transfer. 

The risk of chromosomal errors is higher in older women, especially those above 40, than in younger ones.

Maternal Age

Maternal age remains one of the biggest contributing factors to increased risk of miscarriage, both with natural and IVF conception. Women have a fixed number of eggs in their ovarian reserve. As these eggs age, the process responsible for chromosome division loses its effectiveness. This results in too few, too many, or missing chromosomes. 

The egg quality diminishes after 35, and almost half of the eggs are chromosomally abnormal by age 40. IVF can bypass fallopian tube defects or low sperm count issues, but it can’t magically reverse age-related decline in egg quality, which eventually results in chromosomal defects in the embryo.

Uterine Issues

Even when the embryo has been successfully transferred, the chances of a pregnancy depend on how well the embryo attaches to the uterine lining. Uterine anomalies or certain conditions that reduce blood supply to the endometrium or distort the uterus make implantation difficult. Here are some uterine conditions that might increase miscarriage risk after IVF.

• Fibroids: The most common cause is fibroids. Submucosal fibroids can affect blood flow, as well as the space available for the embryo to implant. Not all fibroids present a risk, though. The smaller ones located on the outer surface may have no impact on your pregnancy.
• Polyps: Endometrial polyps present the same risk. Depending on their size and location, they can increase uterine inflammation and interfere with the pregnancy. 
• Thin Endometrial Lining: An ideal endometrial lining for pregnancy is between 8 mm and 12 mm. Even though pregnancy with a thin endometrial lining is still possible, the environment may not be very favorable for the developing embryo.
• Congenital Defects: For pregnancy to continue, your uterus must be in an optimal shape, have sufficient space, and have an uninterrupted blood supply. Congenital or birth defects in the uterus, such as a bicornuate uterus or a septate uterus, can present implantation challenges by limiting space for the baby’s development, as well as, affecting blood supply.

Hormonal Imbalance

Early pregnancy depends heavily on the right hormonal balance. The most crucial hormone that supports pregnancy is progesterone. It creates a receptive uterine environment to allow the embryo to implant and grow normally. Slow rising or low estradiol in the early weeks of pregnancy, elevated prolactin levels, and poorly controlled thyroid are also linked to increased risk of miscarriage after IVF.

Immune or Blood Clotting Disorders

Immune or blood clotting disorders are other possible, though less common, causes of miscarriage after IVF. Antiphospholipid syndrome (APS) is one such autoimmune disease that forms dangerous blood clots in your veins and arteries, reducing blood supply to the fetus and increasing the risk of pregnancy loss. Thrombophilias, which are a group of inherited blood clotting disorders, have also been found to affect pregnancy outcomes.

Lifestyle Factors

Lifestyle factors can contribute to better reproductive health, which may help you conceive or have a successful live birth. Let’s see some common lifestyle changes that can help couples planning to undergo IVF.

• Quitting Smoking: Chemicals in tobacco can damage egg quality, sperm quality, and increase oxidative stress, all of which are linked to higher miscarriage rates. If you are an active smoker, quit months before you plan a pregnancy.
• Obesity: Obesity causes inflammation, insulin resistance, and poor endometrial receptivity, all of which raise miscarriage risk.
• Poor or Inadequate Diet: Poor diet alone isn’t strongly linked to miscarriage, but it can negatively affect your reproductive health. A diet full of junk, unhealthy fats, and sugars, with low nutritional intake, can contribute to an increased miscarriage risk, especially if you have existing medical conditions that make pregnancy unfavorable.

Underlying Medical Conditions

Certain medical conditions can also increase the risk of miscarriage after IVF. 

• Polycystic Ovary Syndrome: PCOS, an endocrine disorder, can slightly raise miscarriage risk after IVF, especially if insulin resistance, excessive weight, or hormonal imbalances are in the picture.
• Thyroid Disorders: Proper thyroid function is crucial for the baby’s brain development in the early stages of pregnancy. Both hyperthyroidism and hypothyroidism are linked to increased miscarriage risk.
• Diabetes: Poorly controlled diabetes can increase the risk of miscarriage, as elevated blood sugar acts as a toxin that can disrupt embryo development.

Autoimmune disorders and other health conditions, such as chronic hypertension, kidney disease, and pre-existing heart issues, can also cause pregnancy loss.

How Can Miscarriage Risk Be Reduced?

Certain underlying factors that increase the risk of miscarriage during pregnancy are not in our control. For example, chromosomal defects due to age-related quality issues in the egg cannot be changed. 

However, some medical strategies, along with lifestyle modifications, can improve your reproductive health by reducing oxidative stress, improving hormonal balance, and creating a favorable uterine environment for conception. 

Below, we’ve compiled a list of tips that can improve your odds of getting pregnant through IVF while reducing the miscarriage risk.

Before IVF

Preparation for an IVF pregnancy starts way before ovarian induction. Here’s what you can do before IVF to reduce miscarriage risk.

Reproductive Health Assessment 

Your fertility expert will likely conduct a detailed physical examination to understand your reproductive health. Detailed imaging tells them whether your uterine cavity is in good shape to accommodate an embryo.

They may also check your thyroid levels, blood sugar levels (if you have pre-existing diabetes), blood pressure, and overall hormonal health. 

Genetic Screening (PGT)

In selected patients, Pre-implantation Genetic Testing may help detect chromosomally abnormal embryos. It’s needed for patients who have had recurrent pregnancy losses.

It involves removing cells from the embryo and examining their genetic material to detect chromosomal abnormalities. Again, PGT cannot reverse existing chromosomal defects in the embryo, but it can select a euploid embryo that may offer a higher chance at successful implantation. 

Optimize Your Health 

A healthy body and reproductive system create an ideal environment for the embryo to thrive in your uterine cavity. Certain factors have been linked to increased miscarriage risk in natural, as well as IVF pregnancies. Heavy smoking, excessive alcohol intake, and being overweight or underweight are a few such contributing factors that increase miscarriage risk.

Folic acid is usually started before conception. Do not take random supplements that are advertised as “Beneficial for IVF patients”. Instead, discuss your nutritional requirements with your fertility doctor and take prescribed supplements only.

During IVF

As soon as IVF starts, the goal shifts to creating healthy embryos. The process involves multiple steps until the eggs are fertilized in a petri dish in a controlled environment. The most crucial part of this entire process is embryo selection.

Proper Embryo Selection

An embryologist monitors an embryo’s growth and division in the lab. Advanced monitoring equipment, such as a MIRI time-lapse incubator, helps assess embryos’ development round-the-clock through detailed imaging. 

While appearance gives important clues, a more advanced test, such as PGT-A (as discussed above), is necessary for detailed analysis. The test results, along with the assessment, are considered for selecting the most viable embryo for transfer. The main goal is to select a normal and healthy embryo that’s likely to keep developing in the uterus after transfer. 

Hormonal Support

IVF pregnancies require hormonal support, which may include progesterone, estradiol, and other supplements that help build the uterine lining, preparing it for implantation. Progesterone is particularly important for frozen IVF cycles, as you must have received this hormone for a specific duration before embryo transfer. 

The doctor may use ultrasounds and hormone tests to determine current hormonal levels. Accordingly, they may schedule your embryo transfer date, allowing your uterine lining enough time to thicken to support implantation. 

After Embryo Transfer

Your job doesn’t end after embryo transfer. Here’s what else you need to do to mitigate miscarriage risk.

Continue Your Medicines

Hormonal medicines are often needed for several weeks, especially for frozen embryo transfers, as you may not have a corpus luteum. Do not stop taking progesterone even if you experience bloating, mild cramping, or spotting unless your healthcare expert advises. 

Mild spotting accompanied by cramping can occur during the early weeks of gestation and is usually the sign of implantation. Your doctor will run blood tests regularly to monitor HCG levels, which should rise steadily in the early weeks. Later, an ultrasound is scheduled to locate the embryo in your uterus and check its cardiac activity. 

Physical Activity is Okay

A common misconception that many people have is that they need complete bed rest after embryo transfer. Unless your doctor specifically advises, complete bed rest after IVF isn’t necessary. 

For most women, there’s no restriction on moving around, doing light household chores, or carrying out routine physical activities. However, smoking, alcohol, poor dietary choices, or activities that can affect pregnancy should be strictly avoided. 

Signs of Miscarriage After IVF

Signs of miscarriage may vary, and many symptoms that seem alarming can be normal signs of a healthy pregnancy. The more concerning symptoms that can indicate an early pregnancy loss include:

• Heavy vaginal bleeding with blood clots
• Severe abdominal cramps
• Persistent and severe lower back pain
• Sudden disappearance of pregnancy symptoms

Some miscarriage symptoms might overlap with normal pregnancy symptoms, as mentioned earlier. Mild spotting, mild cramps, and even a gradual decrease in pregnancy signs can all be normal. If any symptom seems unusual, it’s best to consult your fertility doctor.

Emotional Impact of Miscarriage After IVF

Losing a pregnancy after a successful IVF can be emotionally challenging. After months or even years of treatments, home remedies, and consultations, the feelings of guilt, fear, anxiety, and stress are common after a miscarriage. 

What’s important to remember is that miscarriage rarely happens because of your fault. Talk to your fertility specialist to find out what exactly went wrong and consult a counselor if needed. They will help you process the loss in a healthier way.

Can You Get Pregnant after an IVF Miscarriage

Yes, many women who have faced a failed IVF or experienced a miscarriage after conceiving through IVF conceive successfully in subsequent attempts. Before starting the next cycle, your fertility doctor will carefully review your health, how you responded to the previous cycles, your hormone health, and other factors. This allows them to personalize the treatment protocol based on your health and ovarian response.

FAQs

What causes miscarriage after IVF?

Chromosomal defects are the most common cause of a miscarriage after IVF, but other factors, such as uterine anomalies, hormonal imbalance, and lifestyle factors, can also contribute.

Is miscarriage common after IVF?

The miscarriage chances after IVF are almost similar to those in a natural pregnancy. The risk depends on maternal age or underlying conditions that create an unfavorable environment for pregnancy.

How can miscarriage risk after IVF be reduced?

Genetic testing, proper hormone support, and a healthy lifestyle are a few ways to reduce the risk of miscarriage after IVF.

What is the miscarriage rate in IVF?

It varies between women, but those above 40 have a slightly higher risk of a miscarriage after IVF compared to younger women.

Does IVF increase miscarriage risk?

No, IVF doesn’t increase the miscarriage risk. In most cases, the factors responsible for miscarriage in a natural pregnancy afre the culprits behind a pregnancy loss after IVF.

Can stress cause miscarriage after IVF?

There’s no scientific evidence that links everyday stress directly with a miscarriage, but chronic stress that disrupts your hormonal balance can be a contributing factor.

How soon can you try IVF again after a miscarriage?

It depends on your emotional stability and the cause of the miscarriage. Talk to your fertility expert to figure out the perfect timing to try again after a miscarriage.