Why do I experience miscarriages after IVF?

In this webinar session, Dr German Fernández, Medical Director, Gynaecologist specialising in Reproductive Endocrinology and Infertility at UR Vistahermosa Managua has discussed miscarriages causes, available diagnosis and treatment options. Dr Fernández started by explaining that miscarriages are very common and around 10 to 20% of spontaneous pregnancies end in miscarriage. Most of them, around 80%, happen before 12 weeks and from 60% of a positive pregnancy test, 34% end in happy ending pregnancy. It is important to understand that even if you do an IVF treatment or not, there is a certain percentage probability of having a miscarriage. Many times people are wondering about how you can have a miscarriage if you are doing an IVF process, but even if you don’t use an IVF process, you can have a miscarriage as well as you can have, for example, preeclampsia, pre-term delivery, diabetes or whatever disease you may have in a normal pregnancy.

Miscarriages – causes

One of the main questions the patients ask: Is it me? Am I doing something wrong? And what is significant to remember is that egg quality is different from egg quantity. Sometimes even though you have a good AM level and Antral Follicle Count doesn’t mean you have a very good quality of those eggs. Another reason for miscarriages could be an underlying disease, such as untreated subclinical hypothyroidism, insulin resistance, or any previous diseases. It is also known that if the progesterone levels are low in the luteal phase, the risk of miscarriage increases. Therefore, many times in an IVF process, we prescribe vaginal progesterone for patients to increase their levels. It is also important to mention the male part. Sometimes we have a sperm analysis that says there is good concentration, very good motility and morphology, but we don’t know if this semen is indeed of very good quality. That’s the reason we do some other tests, for example, DNA fragmentation, and FISH, we also need to check if the partner has diabetes, ejaculation issues, if he smokes and if there were any previous miscarriages. Studying men is as significant as studying women. Sometimes the cause can be found in both partners. The lab also has some responsibility, for example, creating an optimal environment for fertilization, and having an adequate preparation of patients, therefore, we always need to calculate the right dosage for each patient to obtain very good eggs. If we know, for example, that the progesterone levels are high, we freeze the embryos and do a transfer in a later cycle. Another crucial part is personalized treatment because not all patients need the same thing.

Improving IVF results

There are certain things that all patients undergoing IVF should remember and which can be crucial in their journey. These are:

• preparation
• following the doctor’s instructions
• if there are some questions or doubts, always ask and don’t hesitate
• ask about your own pregnancy chances and live birth rate

I would also recommend all patients to take notes about their cycle because if you need to change your doctor, you will be able to provide thorough information. I would always ask how long you’ve been trying for, how was your egg retrieval, have you got mature eggs, did they fertilize, what grades your embryos were or if you had an easy or difficult transfer, etc. Thanks to that, I could probably provide a bit different prognosis. Those questions are very important to answer, and you have to take notes.

Basic tools for surviving an IVF cycle

• keep connected with your friends and family, and ask someone you trust about giving you accurate information
• get as much information as you can get from your doctor, no Internet or forums
  • keep in mind, that there is no ‘formula’ that works for everyone
  • there are other issues than just information from the clinic such as empathy, ability to give suitable information, communication skills, clinical practice
  • information on forums can be influenced by the character, personality, and sensitivity of the author
• trusting your doctor is the most important thing during the process

Another thing you should take into account is to find the answer if it’s better to transfer 1 embryo or more embryos at once. That always depends on the embryo classification, but also regulations in your country. Another thing is to consider the risk of twins or triplets if more embryos are transferred. At some point, you also might need to decide whether to change one of the gametes and also how far would you like to go through your process because if there’s a problem with let’s say your eggs or your partner’s sperm, you might need to change to egg donor or sperm donor to achieve a healthy baby.