We always find that when couples visit our clinic, they inevitably have lots of questions, and indeed, this is something that we encourage. One topic that frequently gets discussed is regarding the chances of miscarriage with IVF treatment. Of course, it is a sensible question, especially for couples who are already enduring the heartache of struggling to conceive naturally. We are always open and honest with couples and discuss their situation on an individual basis addressing their questions and concerns.
As the top fertility clinic in Bangkok, we pride ourselves on the levels of care afforded to patients. Miscarriages and IVF treatment has been the subject of numerous studies which have been conducted worldwide. While the number of incidences reported varies significantly, we can conclude that there is a slightly elevated risk of miscarriage with IVF compared to couples who conceive naturally. However, if you are having fertility issues, IVF treatment may be the best course of treatment, so you need to decide as a couple, if you are emotionally and mentally prepared should the worst happen.
Why is there an increased risk?
The first point which is critical that stress is that researchers are almost unanimous in their belief that the increased risk is not due to the IVF procedure itself. The elevated risk is usually caused by reasons that existed before treatment or happened after the embryos have been implanted back in the uterus. Once again, it is essential to emphasise that this is the case for all forms of fertility treatment and not just IVF.
To try and put this in laymen’s terms, couples who need fertility treatment appear to be predisposed to miscarriage. The method of conception, therefore, could not be constituted as a significant risk factor. However, below we have outlined some of the potential reasons why the number of miscarriages experienced by couples who have undergone IVF treatment appears to be higher.
The natural aging process
Statistically, many couples who seek assistance with fertility issues are of an advancing age when their fertility levels are naturally on the decline. There is plenty of evidence to show that the higher the maternal age, the higher the association there is with miscarriage. Indeed, it is noticeable that women over 35 have an increased risk of miscarriage or other fertility issues compared to a woman in her twenties. According to the American Pregnancy Association, women aged 35-45 have a 20-35% risk of miscarriage, but this rises to 50% in those over 45.
Other underlying health problems
It is vital that couples appreciate that other underlying health issues may cause fertility problems, which is why it is so important for couples to visit their doctor if they are having problems conceiving. The problems often relate to lifestyle issues such as obesity, alcohol abuse or a poor diet and can be quickly addressed. However, other more serious conditions may be identified and further treatment required, not only to reduce your chances of miscarriage but for your overall health and wellbeing.
There is little surprise that those who are in better general health experience less incidence of miscarriage. Being open and honest with your doctor about any issues you may be experiencing is the only way they will be properly addressed and the chances of miscarriage potentially reduced.
One potential risk factor that is in some ways connect to the IVF process is the amount of ovarian stimulation that is required during the assisted fertility process. Again, the link is thought to have a more significant underlying correlation to pre-existing factors rather than the treatment itself. Still, a 2004 study found that women requiring higher levels of ovarian stimulation reported a higher incidence of miscarriage. Unfortunately, the study did not thoroughly investigate the reasons associated with this, and we would stress that technology has improved dramatically in recent years.
Recognising any problems early
Regardless of whether you conceive naturally or need some assistance, couples should pay close attention to the female’s menstrual cycles and any unusual body changes that she experiences throughout the pregnancy. Needless to say, if you do have any concerns, you should contact a medical professional immediately.
The chances of miscarriage are highest in the first trimester, or to put that simply, in the first few weeks of pregnancy. It is not unusual for women who have conceived naturally to suffer a miscarriage before they know they are pregnant – something known as a “chemical pregnancy”. Of course, if you have experienced fertility issues in the past, it undoubtedly pays to be extra vigilant in the first trimester and, indeed, throughout the pregnancy.
Is there anything that can be done to reduce the risk?
For older couples, such as those where the female is over the age of 40, we will often discuss using an additional technique known as Preimplantation Genetic Diagnosis (PGD), as this helps to ensure that only healthy embryos are implanted back in the uterus. If you have a history of miscarriage, it may also be worth asking your doctor for their opinion regarding whether it could be beneficial. Indeed, a study conducted in 2006 found that miscarriage rates in women aged 35-40 who used PGD fell to 14% from 19% and in those over 40, it fell from 41% to 22%.
Should the elevated risk dissuade you?
At the first consultation, we will always talk to couples about the risks involved with any fertility treatment. Being realistic about the risks will help you cope should you need to. We would say that the elevated risk shouldn’t be a reason for deciding against having IVF treatment for most people. Naturally, it will come down to personal choice, and you should never feel pressured into making a decision one way or the other. As a couple, you will need to be strong and be there to support each other throughout. Remaining positive and thinking about bringing a new life into the world will certainly help!