How to prevent an early miscarriage after egg donation?

Fertility Seminars

In a naturally conceived/normal IVF pregnancy, first trimester bleeding is often an indirect sign that there is something wrong with the embryo. But in egg donation pregnancies, bleeding in the first trimester does not tell us anything about the embryo’s destiny. Using additional medication in time often helps to maintain an egg donation pregnancy when bleeding occurs. Our patients are  provided with this medication and instructions in advance. 

Bleeding in the first trimester of a “fresh own egg” pregnancy

In “fresh own egg” pregnancies, first trimester bleeding is often an indirect sign that the embryo is not doing well. Bleeding occurs if the progesterone/estradiol concentration around the uterus falls, which is often the result of a decrease in HCG production by the embryo. This decrease in HCG production by the embryo means that the embryo is stopping or has stopped its growth. This happens mainly if the conditions within the embryo are not adequate for further development. This sad process is designed by nature to eliminate all embryos which have spontaneous genetic problems. The higher the age of an egg used for conception (which is the same age as the woman who produced it), the higher the risk of spontaneous genetic problems in the embryo, and the more often embryonic development stops in the first trimester, reaching a 50% risk in women above 40 (link to Figure 4: Miscarriage rates for women using their own eggs in IVF treatment)

Because bleeding in an early “fresh own egg” pregnancy is just a secondary problem (an indirect sign of a decrease in HCG), there is nothing to be done to help the woman keep the pregnancy. Local consultants usually recommend stopping hormonal support, explaining that the pregnancy is probably “not good”.

Bleeding in the first trimester of an egg donation pregnancy

Because there is no progesterone support from the woman’s own body in the first trimester of pregnancy after egg donation, this support must be provided by medication in a fairly strong form. Progesterone is taken as vaginal pessaries or gel, or even as intramuscular injections. Oestrogens are taken as tablets orally or via transdermal patches or gel. Because the doses of hormones given are already quite high, they do not grow together along with the embryo’s demand in the way this happens in a “fresh own egg”  pregnancy. Furthermore, absorption of drugs from the stomach, the skin and the vagina sometimes may be not perfect and their concentration in the uterine blood flow may temporarily decrease. The uterus may answer to such a decrease with a menstrual-like reaction which will result in a first trimester bleed.

In my experience, every 5th women who gets pregnant through egg donation experiences some form of bleeding in the first trimester.

Unlike in “fresh own egg” pregnancies, bleeding in the first trimester after egg donation does not tell us anything about the embryo’s destiny. It simply happens because the artificial hormone substitution in the first trimester, though effective, is far from being as good as the woman’s own hormones, because it is not regulated by the needs of the embryo via HCG and the yellow body. In this case, a bleed does not tell us that the embryo is bad, dying or has died. It simply indicates that in the uterus there is a shortage in externally submitted hormones. Because a young egg has been used for creating the pregnancy, the risks of genetic problems in the embryo, and of miscarriage, are as low as for a 20 to 30-year-old woman, i.e. less than 14% (link to Figure 4: Miscarriage rates for women using their own eggs in IVF treatment) The embryo is usually alive and kicking, and may even not notice that there was a bleed, if you manage to stop it quickly.

How to prevent miscarriage if a bleed occurs in the first trimester of your egg donation pregnancy

We inform all our patients in advance about the steps they have to undertake to stop any bleeding that may occur. We also supply them with medication that can stop the bleeding, and instructions on how to use it. In this way, you will have everything you need at home in case such an emergency situation arises.

Due to giving these detailed recommendations to my patients in advance and keeping in contact with them, we have helped 82% of those with a positive clinical pregnancy test (a pregnancy confirmed by ultrasound) to give birth to a baby. The miscarriage rate of 18 % is only 4-6% higher than for “fresh own egg” pregnancies in 25-year-old women. (link to Figure 4: Miscarriage rates for women using their own eggs in IVF treatment)

In the last few years, we have maintained a clinical pregnancy rate of 60% and a live birth rate of 49%. (This means that 60% of fresh embryo transfers of 2 embryos have resulted in clinical pregnancies, and 49% of fresh embryo transfers of 2 embryos have resulted in a live birth).