IVF and miscarriage are two very important topics when it comes to infertility and fertility options. While miscarriage is an incredibly challenging experience, it does not mean you can never become pregnant. IVF is one possible option for treating recurrent, or repeated, pregnancy loss.
What Is a Miscarriage?
Miscarriage refers to the unexpected loss of a pregnancy before the 20th week of gestation. An isolated miscarriage, meaning a one-time event, is actually very common. In fact, studies estimate that around 30% of all pregnancies end in an early miscarriage (before 6 weeks of gestation). That number may be even higher, as some individuals miscarry without even realizing they were pregnant.
The loss of more than three pregnancies in a row is called recurrent pregnancy loss or recurrent miscarriage. We don’t know the exact occurrence of recurrent pregnancy loss, but studies suggest it affects 2-5% of people who become pregnant.
While some factors can raise the risk of miscarriage, it occurs in people of all ages, backgrounds, and health histories. Miscarriage can happen both in natural pregnancies and in pregnancies from assisted reproduction techniques such as in vitro fertilization (IVF).
What Causes Miscarriages?
Some miscarriages occur because of anatomical, hormonal, immune, or other physical issues. However, most miscarriages that happen during the first trimester come from a chromosome imbalance in the embryo. Chromosomes contain an individual’s genetic material. A normal, or euploid, human cell has 23 matched pairs of chromosomes. On the other hand, aneuploid cells have missing, swapped, or extra chromosomes, which can negatively affect an embryo’s development. Some instances of aneuploid cells lead to chromosomal disorders. In many other cases, the embryo simply stops developing and results in a miscarriage.
As eggs age, their chance of containing chromosomal abnormalities increases. This, among other factors, increases the risk of early miscarriage in people who become pregnant in their late 30s and older. Genetically testing an embryo can help identify abnormalities and determine if an embryo is euploid. Because we must test the embryos outside of the body, this treatment option for miscarriage requires IVF.
What Is IVF?
IVF stands for in vitro fertilization. In IVF, an egg and sperm are retrieved and combined in a lab to create an embryo, which is then transferred to the uterus for implantation. The patient takes different hormonal medications to stimulate the ovaries and produce several mature eggs for retrieval. The egg retrieval procedure is relatively minor; after the retrieval, the eggs can be combined right away with fresh sperm or cryopreserved (frozen) for later use. Once the egg and sperm are combined, the resulting embryo can also either be transferred right away or cryopreserved for later use. There are several options for IVF, including different kinds of medications, different approaches to the fertilization process, and genetic screening for the embryo. Each IVF cycle can take 4-8 weeks from initial medication to implantation, depending on several factors.
How Does IVF Help With Miscarriage?
As noted, genetic errors cause the majority of first trimester miscarriages. Because IVF involves developing an embryo outside of a uterus, it provides the option to test the embryos before implanting them. This testing, called preimplantation genetic testing (PGT), can screen for different chromosomal issues, including the number and matches of chromosomes, and even certain specific genetic disorders. At the same time, PGT also identifies euploid embryos with the best chance of successful implantation and pregnancy. Selecting an embryo with the highest likelihood of success can help reduce the risk of miscarriage, whether isolated or recurrent.
IVF also provides the option of using donor eggs to conceive. Because egg quality and quantity decreases with age, the chance of miscarriage or unsuccessful implantation increases. Patients with repeated unsuccessful IVF cycles may consider using donor eggs. These eggs come from donors ages 21-29 who have passed fertility, genetic, and health evaluations. As the chance of chromosomal abnormalities relates to the age of the egg, not the person conceiving, donor eggs can provide a higher chance of pregnancy for some women.
IVF After Miscarriage
If you have experienced miscarriage, your fertility specialist may recommend IVF after evaluating your health history and testing for any non-chromosomal causes. How soon you try IVF after a miscarriage depends on your emotional health as much as your physical health. Physically, your body may need time to recover, especially if you experienced miscarriage during an IVF cycle that involved hormone medications and an embryo transfer. Emotionally, pregnancy loss is a deeply emotional and distressing experience. It’s important to take care of yourself and your mental health, and to only try for another pregnancy if and when you feel ready. Your fertility team should communicate openly and compassionately with you to help provide resources and offer options. You can find several resources in our articles, at our Center for Recurrent Pregnancy Loss, and in Dr. Shahine’s book, Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss.
If you have experienced a miscarriage, know that you are not alone. Take care of yourself and reach out for support. If you are ready to try again, we are here to help.