A miscarriage after fertility treatment

Miscarriage is a very painful experience. This blog discusses the question of how miscarriages can be emotionally processed after fertility treatments. In addition, the methods of modern reproductive medicine are shown, thanks to which it has been used in recent years possible was to significantly reduce the risk of termination. In the previous blog post, Dr. Ana Chueca from IVI Zaragoza, the fertility center, identifies the main risk factors for an unwanted termination of pregnancy.

Dr. Chueca, what psychological support does IVI offer to patients who are struggling with the fear of having another miscarriage or who can hardly imagine any further treatment despite the desire to have children?

Many couples who have already had one or more miscarriages come to IVI, regardless of whether after natural pregnancy or fertility treatment. The job of our IVI psychologists is to assist and deal with the couples in processing their loss healthy and positive ways to make them feel ready for another pregnancy. Miscarriages are a very challenging experience for everyone, because they are diametrically opposed to the belief in a natural life cycle: parents die before their children. Understandably, abortions cause great doubts and fears. However, they can be managed together.

Here’s how we tackle the issue:

the aim is, to replace negative thoughts with positive ones. It is a difficult task at first. There is the blame for doing something wrong and causing the miscarriage, the struggle and grief for the baby and the fear that it could happen again. The task of the psychologists is to convey that the negative experience does not have to be repeated and that one deserves a new pregnancy.
It is important, complete trust in medical personnel to develop. IVI will make every effort to achieve a new pregnancy that leads to the birth of a child. It is important to break the spiral of fear and guilt in order to understand that we must first be well to make the desire to have children come true.
It makes sense from the baby that you couldn’t get to know, take farewell. It helps some people to write a letter, talk to others, aloud or in thought. Some visit their special place of memory. It is important to be able to complete our struggle and the bad experience.
We have to accept that the lost child cannot be replaced by any other.
With our partner or a close person talk about our feelings being able to help is of great help. Sometimes we tend to keep the emotions to ourselves because we believe that nobody will understand us or that we are considered weak. An important part of emotional health is expressing our emotions and thoughts. To be able to put into words what our heart feels. Many people experience great relief after being given the opportunity to express their feelings. Take this room! If you think there is no one in your family or friends group, look for professional support! Our IVI department for emotional support will be happy to listen to you and guide you through your process. It is crucial for us that you can go through the fight because of the loss, but also that it is possible to enjoy a new pregnancy afterwards.

Should you pause after a miscarriage before starting new fertility treatment? There is a recommended period of time?

There are a number of factors to consider for a correct answer. First, the type of miscarriage needs to be clarified. If there was a biochemical pregnancy alone, so the pregnancy test is positive, but the pregnancy not yet can be seen on ultrasound and miscarriage occurs at this earliest stage, fertility treatment can be started again with the next menstruation if the HCG value has been negatively corrected again.

If it is already a clinical pregnancy visible on ultrasound, a distinction is made between early and late abortions. One speaks of a late miscarriage after the 12th week of pregnancy.

If the termination occurred before this week, it must be seen how the uterine cavity was emptied, whether by scraping or by means of an abortion with medication. In the latter case, the child resuming fertility treatment is waited until the uterine cavity has been completely emptied and the HCG values are in the negative range. The treatment can then be started again with the subsequent menstruation.

In the event of a late termination, a birth with subsequent scraping must be initiated in some cases. In these cases, you are advised to take a break of at least three months before the next fertility treatment. Of course, the patient’s psychological state of mind must also be taken into account. IVI offers them the necessary psychological support in a loving and understanding manner (care concept of the Tender Loving Care). The stress caused by the termination of pregnancy must be reduced in order to be able to tackle the challenge of a new pregnancy more easily.

The number of involuntary abortions has declined significantly in recent years. What measures is this success due to??

Right from the start, the IVI group has invested enormous human, technological and scientific resources to reduce the miscarriage rate.

Thanks to the advances in medicine, biology, genetics and technology in recent years, we are able to diagnose diseases that were previously unknown or treatable.

Here is a brief overview of the progress in reproductive medicine:

Preimplantation Diagnostics (PID) and Preimplantation Genetic Screening or Screening for Aneuploidy (PGS): Preimplantation diagnostics and screening on the embryo have developed enormously. When choosing the best embryos using PGS, the probability of pregnancy has increased by 70%. By transferring the best embryos, the success rate increases and pregnancy can be achieved more quickly. Preimplantation procedures have multiplied the likelihood of pregnancy with the first treatment to have children. The early detection of chromosomal disorders in the screening only transfers healthy embryos, which reduces the risk of miscarriage and at the same time increases the likelihood of a healthy baby.
Endometrial receptivity array: By taking a small, almost painless sample of the endometrium and then analyzing more than 600 genes, we can determine whether the endometrium is receptive (receptive) or not (pre- or post-receptive). This allows the best moment of embryo transfer to be determined so that implantation can take place correctly and no termination of pregnancy is provoked by an incorrect time window for the implantation.
Genetic Compatibility Test (GKT): With the GKT, which consists of a simple blood test from the expectant parents, more than 600 so-called rare diseases can be excluded. If a disease is discovered, the couple must decide together with the fertility doctor whether pre-implantation diagnosis should be carried out on the gametes (egg and sperm cells) in order to prevent the disease from being passed on. This prevents egg and sperm cells with the same genetic predisposition for an illness to be brought together for fertilization.
Reproductive immunology: The IVI immunologists carry out a complete analysis of the immune systems of both future parents. Among other things, Autoimmune processes, the settlement of uterine NK cells (natural killer cells) important for pregnancy and the values of HL antigens are determined. Depending on the diagnosis, different strategies are used for fertility treatments, e.g. immunological treatments, the selection of gametes or the recommendation to transfer a single embryo (single embryo transfer).
Endocrinological analysis (hormone analysis): At IVI, we rely on a holistic assessment of the factors of both partners. Diseases such as diabetes, thyroid dysfunction or extreme obesity are related to a higher miscarriage rate. Therefore, prior evaluation of the values and, if necessary, appropriate treatment are crucial to increase the likelihood of a successful pregnancy.
Advances in surgery: Changes in the uterus, whether congenital or acquired during life, can be the cause of a miscarriage. Minimally invasive endoscopy allows surgery with significantly less blood loss, better diagnostics and thereby the medical improvement of the uterine conditions that triggered the miscarriage.
The development of 3D ultrasound: With a simple to perform 3D ultrasound, it is possible to better recognize clinical pictures in the area of the uterus and the endometrium. A diagnosis can be made quickly and painlessly without the need for a surgical intervention.

A lot is possible today, but as long as miscarriages cannot be completely avoided, IVI will continue to research and strive to improve the techniques of reproductive medicine. The goal is clear: IVI wishes all of its patients “a healthy born child at home”.

We would like to thank Dr. Ana Chueca.