Pursuing pregnancy with in-vitro fertilization can be an exhausting and challenging process, both physically and emotionally. As such, those who conceive using IVF may worry whether they have an increased risk of miscarriage. As with couples who conceive naturally, though, the rate of miscarriage those who have IVF is primarily affected by maternal age and individual health. Nearly half of all women younger than 40 find success with IVF.
Maternal Age Is a Factor
The likelihood of miscarriage following IVF is as common as miscarriage with a natural conception, and depends on the mother's age at the time of conception, as well as whether she has any underlying health concerns. Approximately 46 percent of women under the age of 35 will conceive via IVF, with nearly 40 percent of those pregnancies resulting in a live birth, notes the Society for Assisted Reproductive Technology. With each passing year, that rate drops significantly; only 8.9 percent of women who are over 42 years old will conceive with IVF, and half of those pregnancies will end in miscarriage.
Age does not appear to affect the success rates of women using donor eggs, with nearly half of all IVF cycles using donor eggs resulting in live births, according to SART. No matter what age you are at conception, using frozen embryos versus fresh embryos can increase a woman's risk for miscarriage, according to Dr. Nasir Rana, medical director of the Reproductive Medicine Institute in Chicago.
As with those who conceive naturally, the miscarriage rates for IVF increase as a result of certain chronic health conditions, Rana says. If you've achieved pregnancy through IVF but then miscarry, you may want to try again.
Repeated miscarriages can be a sign of an undiagnosed health issue, requiring further evaluation. "Repeat miscarriages are usually associated with many factors that individually or collectively may affect pregnancy outcome," he explains. These factors can include diseases like polycystic ovarian syndrome, systemic diseases such as diabetes, lupus or Grave's disease, and uterine abnormalities including fibroid tumors or a uterine septum, he says. Age also plays a role in recurrent miscarriages, according to research published in the Journal of Assisted Reproduction and Genetics; the study found that 63 percent of women age 40 or younger achieved pregnancy and a live birth with their second IVF cycle. For women over the age of 40, the rate of miscarriage with a second IVF cycle did not decrease.
Pre-Screening Is Essential
Proper genetic screening can help women to diagnose and manage chronic risk factors that increase the risk of miscarriage during an IVF cycle, Rana states. "A thorough pre-conception or pre-IVF comprehensive evaluation, based on a woman's past medical, obstetrical and gynecological history and clinical findings, is a must," he says. "A patient should be part of the whole process and fully involved from the get-go. Preimplantation genetic screening and other diagnostic modalities may be needed to fine tune a treatment plan before someone is ready for a new attempt at getting pregnant," he adds.
PGS is typically ordered before IVF when the mother or father has a family history of disease or is a carrier of a chromosomal abnormality, or if the mother is over the age of 35 or has a history of recurrent miscarriage.
Pursuing Other Options
Repeated miscarriages following IVF cycles can be physically taxing and emotionally devastating. At some point, couples may be advised to consider other options, Rana says.
"In a free society, a patient has many options in pursuing her desire for having a family," he observes. "When all the available information is considered, decisions and options may depend on the underlying reasons for lack of success. Some factors are correctable and some are not. We must give them counsel, provide pertinent information to their situation, and give them time to evaluate their decisions."
Depending on the reason for failure, he says, couples may need to consider options such as using a donor ococyte, donor sperm, embryo adoption, gestational surrogacy or adoption. "These are difficult decisions, but ones that need to be addressed," he says.