Donor egg miscarriage – a clinic’s support plan (& next steps)

Donor egg miscarriage is a specific topic – but for anyone navigating, expert support is crucial. Knowing what steps to take, and shaping a plan for recovery can provide a little reassurance across this often-overwhelming experience. 

Why do donor eggs miscarry?

Donor eggs can miscarry for similar reasons as naturally conceived pregnancies, with the most common cause being genetic issues within the embryo, such as chromosomal abnormalities.

While using donor eggs can reduce miscarriage risk by reflecting the donor’s age rather than the recipient’s, it doesn’t eliminate the possibility entirely. And, even with eggs from younger donors and options like preimplantation genetic testing (PGT), other factors like uterine health, hormonal imbalances, or immune responses can contribute to miscarriage.

Regular monitoring and specialist support are essential to understanding and addressing potential risks.

Our go-to for tailored, specific support, leading UK clinical network TFP Fertility bring over 35 years of experience, expert care and guidance to every stage of fertility treatment, including next steps, if things don’t go as planned. 

Right at the heart of Baby Loss Awareness Week 2024, we’ve put together your most-asked questions around donor egg miscarriage and pregnancy loss for TFP Fertility Medical Director, Dr Justin Chu to cover off. Based in the network’s Oxford clinic, Dr Chu specialises in treatment and specific care across embryo implantation, miscarriage and maternal collapse. 

From symptom awareness to first-line support, recovery at home, and follow-up appointments, this is everything to know and request from your team and support network, when navigating egg donation miscarriage, after IVF. 

Over to Dr Chu, and TFP Fertility.

1. How common are miscarriages with donor eggs?

This is a really good place to start – and it’s such an important topic. Specific yes, but crucial for so many people navigating loss following donor conception, or thinking about trying again. 

The first thing to say is that unfortunately, with any IVF treatment – whether that’s with a patient’s own eggs or donor eggs – there is always a risk of miscarriage. This can be caused by a number of things, but the vast majority will be due to a genetic issue within the actual embryo. 

Age is a key factor here. If you’re opting for donor eggs, in theory the risk of miscarriage should tally with the donor’s age, rather than your own. Clinics will have specific age limits for donors – at TFP Fertility we accept egg donors from age 21, up until their 36th birthday. This is to help ensure optimal egg quality, and there’s also the option to go for PGT (preimplantation genetic testing), too. 

But there is still a risk that the donor eggs used to create an embryo may carry a chromosomal abnormality, for example, that could potentially cause a miscarriage.

2. Is a donor egg pregnancy ‘high risk’?

No, it shouldn’t be. I lead the Tommy’s National Centre for Miscarriage Research in Birmingham, and the research shows that unfortunately with any pregnancy there is always a risk of miscarriage – currently around one in four. 

In terms of risk, a donor egg embryo is comparable to a naturally conceived pregnancy. 

3. What symptoms should we watch for (& when)?

For an early pregnancy loss, the most common symptoms we see are pain and bleeding. Characteristically, there will be crampy, lower abdominal pain and then bleeding. This can be quite ‘light’ bleeding, but for some women it will be heavier.

If you’re having any of these symptoms, the first thing to do is contact the fertility unit you’re having treatment with, for support and guidance. At TFP Fertility, our first step will be to run through an assessment with you over the phone, and then we may ask you to come into the clinic. We’ll: 

• make a full assessment
• take a quick history of your profile and treatment to date
• perform an ultrasound scan (if appropriate)
• provide advice on next steps 

Very sadly, there isn’t anything we can do to stop the miscarriage from happening, once it’s started.

4. Is bleeding/spotting always something to worry about, after transfer?

After any embryo transfer, it’s quite common to get a bit of ‘spotting’ (irregular bleeding). For example when we’ve ‘scratched’ the canal or neck of the womb to perform the transfer, this can sometimes disturb a few very small blood vessels in the cervix. This in turn can lead to some spotting straight after the embryo transfer. 

If you get some light bleeding before your pregnancy test, this may also be implantation bleeding – where the embryo is latching on to the lining of the womb. 

Bleeding can also sometimes signify a biochemical pregnancy loss, especially if you’ve already had a positive pregnancy test. I know that this was the case with TRB founder Eloise’s fourth round of IVF, following a frozen embryo transfer. 

At TFP Fertility, we often perform an ultrasound scan at seven weeks of pregnancy – a few weeks after your transfer. If there’s bleeding or pain around this time, it may very sadly indicate a miscarriage. 

Miscarriage timing is very unpredictable, and it does depend how far along you are, in the implantation process.

5. Can taking progesterone help prevent a miscarriage, after transfer?

This is a really hot topic involving a few significant clinical trials, which have looked at using progesterone before and after transfer to prevent miscarriage. 

Currently, there isn’t conclusive evidence as to the strategy we should be using, for progesterone. If you’ve had a previous history of miscarriage then progesterone is definitely something we’d want to discuss, when planning a frozen embryo transfer, for example, or a synchronous donor egg transfer cycle.

6. Does the risk increase, if we transfer more than one embryo?

For many clinics, standard practice is to transfer one embryo. 

With a donor egg embryo transfer, the ultimate aim is to optimise the chances of pregnancy. By increasing the number of embryos we’re transferring, we’d increase the chance of multiple pregnancy – and this carries a higher risk of miscarriage.

7. If we do miscarry, what are the next steps in clinic?

The first step is to get in touch with your clinic, or fertility unit. At TFP Fertility this will be by phone, and we’ll always offer a review as your starting point. We can’t stop a miscarriage once it’s happening, but compassionate support is incredibly important at this time – and that’s what we stand for. 

During that review, we’ll take a quick history and find out what’s been happening. From there, an examination may be required, and perhaps an ultrasound scan depending on how far along you are in your pregnancy. In some cases, it will be too early to see anything on a scan – we’d explain this and the timescales we’re working with during your clinical assessment. 

If you’ve had a positive pregnancy test and are a little further on – for example, at the seven week mark – bleeding or pain may signify a miscarriage, and we’d maybe do one or two confirmatory scans, to understand what’s happening. 

And crucially, we’d connect with our close colleagues within the NHS early pregnancy assessment unit (local to you), to ensure you’re on the right management pathway.

8. What happens after a donor egg miscarriage?

We’ve covered above the steps we’d take in clinic, to support you in the first instance of miscarriage. Once under the care of an NHS early pregnancy assessment unit, they’ll offer a set of options to support and manage the miscarriage process. 

At TFP Fertility, we’ll always advise patients to connect with us as soon as they’re ready, after a miscarriage. From there, we’d review: 

• your notes
• what’s happened within your cycle
• your donor’s egg reserve
• how many eggs were collected in that cycle
• embryo progression from the laboratory

This can help us build a picture of what’s happened during your IVF cycle, although we can’t say for sure why a miscarriage has happened. 

At TFP Fertility, we also have a fantastic team of counsellors, who are experts in the field of fertility and pregnancy loss. Some people do struggle to speak to a doctor, for example, about their loss – having that alternative approach and point of support can really help. 

And, I’d always recommend connecting with charities and groups like Tommy’s and The Miscarriage Association too, for community and expertise.

Editor’s note: This real life story of miscarriage using donor eggs, published by The Miscarriage Association may be a helpful read.

9. What happens if I have multiple miscarriages using donor eggs?

In the case of repeat miscarriage, we may need to think outside of the box. It’s not always a genetic problem, so we’d look at doing some further testing, perhaps looking at things like sticky blood disorders, thyroid problems, further genetic testing, and a few other things.

10. Would we try again using the same donor’s eggs?

While it can be a reflex reaction to think you need to try again with a different donor’s eggs, it’s important to remember that you matched with and/or chose that donor for very good reasons. 

If you’ve had multiple miscarriages, it may be worthwhile having the discussion and reasoning it out – looking into switching to a new egg donor – but this will depend on the embryos you have in storage, which may be suitable for embryo transfer.  

Keen to hear more from Dr Chu? Connect with the team at TFP Fertility – whether you’re looking to regroup ahead of a new IVF cycle, find expert support for repeat miscarriage, have specific donor queries or are just starting out, every conversation starts with their patient-centric approach.   

Read this next: Missed miscarriage – NHS updates, info & most-asked questions, and for more general support, read through our guide to what happens after a miscarriage.