The risk of missed miscarriage after IVF: causes, diagnosis, examinations

Unfortunately, the pregnancy loss topic remains extremely relevant today. The fear of spontaneous abortion is especially strong among women preparing for the IVF protocol.

In this article, we will try to find out whether the risk of pregnancy loss increases with IVF .

According to the statistics, every fifth pregnancy results in miscarriage before the twelfth week. In 70% of cases, miscarriage is due to chromosomal abnormalities in the embryo structure. The risk of such genetic disorders increases significantly in the case of late pregnancy, when the expectant mother is over 35 years old. After 40 years, genetic disorders appear in 80% of embryos.

Potential reasons for early termination of pregnancy

In vitro fertilization per se does not increase the risk of pregnancy loss. The causes of spontaneous abortions are the same both in the case of a natural pregnancy and IVF protocol. We list the main risk factors:

• Late reproductive age. Until menopause, a woman can become pregnant, but pregnancy after the age of 35 is associated with an increased risk of pregnancy loss. So, up to 30 years, the probability of pregnancy loss does not exceed 10%, and at 35 years it is already 20%. After the age of 40, the risk of spontaneous abortion exceeds 80%.
• Smoking increases the likelihood of chromosomal changes in the foetus.
• Forced use of drugs that can cause disturbances in the embryo development. For example, usual Analgin is dangerous for pregnant women. Besides, cosmetic products containing vitamin A and other retinoids have a pronounced teratogenic effect, i.e. popular series for the care of oily and problem skin.
• Fever - an increase in body temperature above 38°C.
• Vitamin B9 (folic acid) deficiency.

On the other hand, there are several factors that are mistakenly considered dangerous for a favorable course of pregnancy. In fact, these phenomena do not carry a threat of pregnancy loss:

• flight by plane;
• a fall; in early pregnancy, even blunt abdominal trauma rarely results in pregnancy loss, since the uterus is reliably protected by the bones of the small pelvis;
• use of hormonal contraceptives (pills, loops) prior to pregnancy;
• usual physical activity. Even serious training is not dangerous if the woman's body is well prepared for it, i.e. woman before pregnancy trained with the same intensity;
• previously made HPV vaccination;
• sexual contact;
• stress;
• previous justifiable abortions.

Ultrasound diagnosis of missed miscarriage

Ultrasound helps to timely detect intrauterine death of the embryo.

The diagnostician gives a conclusion about missed abortion in the presence of one of the following signs:

• The CRL (crown-rump length of foetus) reached 7 mm, thus absent foetal cardiac activity.
• The heartbeat is not detected 2 weeks after the initial identification of the gestational sac.
• The gestational sac is less than 24 mm and there is no heartbeat.
• The size of gestational sac is more than 25 mm but there is no visible embryo.

Experienced fertility specialists recommend not agreeing to curettage after the first ultrasound and insisting on monitoring the foetus development in dynamics. In their practice, there are often cases when a woman is faced with a terrible diagnosis in consultation and sent for surgery. The woman does not agree, writes a refusal, and does an ultrasound the next day. Repeated ultrasound shows the normal development of the foetus. Do not give up hope before its due time and, if there is no general feeling unwell, you can wait for a second ultrasound.

Is there a need for examination after missed miscarriage?

It is important to emphasize that wait-and-see tactics are only suitable in a situation where a woman does not have external symptoms of a pregnancy loss. She has no bleeding, drawing pain in the lower abdomen and dizziness. If such symptoms are still there, you should not delay a visit to the clinic. Doctors will help to safely remove the dead embryo and, if necessary, send it for histological examination. Such a study will help to understand the root cause of miscarriage.

According to clinical guidelines of the Ministry of Health and the world's leading associations of reproductive medicine, a single case of missed miscarriage is not an indication for diagnostics. It is assumed that the pregnancy loss occurred due to an error in the chromosomal structure of the embryo and is a random one-time phenomenon.

If case of recurrent pregnancy loss and spontaneous missed miscarriages, the reasons should be investigated. The exact examination plan is compiled by the attending physician individually, based on a specific clinical picture. The only thing that is recommended under any circumstances is to conduct a karyotype study of the deceased embryo.

Histological analysis will determine the presence of chromosomal abnormalities in the embryo development. If such abnormalities are detected, a favorable diagnosis is given and the probability of a favorable resolution of the second pregnancy is assessed as quite high. If the embryo constitution is normal, then the causes of the pregnancy loss must be sought in parents. The doctor may prescribe a comprehensive health screening of the man and woman, swabs for infections, a check of the hormonal background and the functioning of the immune system, hysteroscopy, biopsy, and other diagnostic procedures. It is the identification and elimination of the real cause of miscarriage that increases the chance of having a baby.

Does the IVF program really increase the risk of missed miscarriage?

According to available statistics, the number of missed miscarriage after IVF significantly exceeds the normal rate. It is known that up to 32% of all in vitro fertilizations are interrupted at an early stage. But these statistics do not consider the effectiveness of preimplantation genetic diagnosis, which reduces the risk of spontaneous abortion by 20% in couples with recurrent miscarriage. PGD allows you to select a healthy embryo without genetic abnormalities.

The increased risk of miscarriage after IVF is not associated with the procedure itself, but with the reasons that forced the couple to use the protocol:

• a violation of spermatogenesis;
• chronic inflammatory and infectious diseases;
• advanced reproductive age;
• endocrine disorders.

Before IVF, chronic diseases are translated into remission, but hormonal failure during pregnancy often reactivates them. Only careful preparation for the procedure, highly professional embryo transfer and careful monitoring of pregnancy can increase the chance of success.

Choosing the right clinic is an important step towards motherhood.