What happens if I miscarry with donor egg(s)? A clinic’s support plan

Donor egg miscarriage – a leading clinic’s approach

Tying in with Pregnancy Loss Awareness Month, we sat down with Dr. Justin Chu, Medical Director and Person Responsible at TFP Fertility, to walk through a donor egg miscarriage support plan.

From symptom awareness and first line of support to recovery at home and follow up with your doctor and team, watch as we answer:

• How common are miscarriages with donor eggs?
• Is a donor egg pregnancy ‘high risk’?
• What happens if I miscarry with donor eggs?
• What are the next steps in clinic?
• How soon can I try again, if I want ti?
• Would I try again using the same donor’s eggs?
• And much more

If you need more support this month – or want to get started with donor egg conception, or learn more about any of the topics we’ve covered today – make sure to touch base with the amazing team at TFP Fertility.

Their UK-wide clinical network offers second-to-none, full-service fertility support, wherever you’re at.

Transcript

Eloise Edington

Hello, welcome everyone! Today it’s nice to be going live. I am going to be chatting with Dr. Justin Chu, who is the Medical Director and person responsible at TFP Fertility. Being October, Baby Loss Awareness Month, we are going to be discussing miscarriage, the “what ifs,” and all the questions you would like to ask from a leading fertility clinic and specialist around support, next steps, reasoning, and various treatment options. 

Hello, welcome to those who are joining! It’s lovely to see you today. I’m going to see if Dr. Chu is here now and then we can go live. If anyone has any questions for him while we’re chatting, please don’t hesitate to ask. That’s what he’s here for and absolutely what he will want to help you with today.

We’re going to be talking about how common miscarriages are with donor eggs. Is a donor egg pregnancy high-risk? Also, in terms of treatment options, symptoms to look for, what might be a red flag, and any timelines you might need to think about. 

So, bear with me — he’s here now and we can get started. Hi everyone, thanks for joining! Nice to see you today. Dr. Chu is joining now from TFP Fertility. Hello, welcome! Good afternoon, Dr. Chu.

Dr. Chu

Hi, Eloise, good afternoon. Nice to see you today.

Eloise Edington

I’ve just given an introduction to TFP Fertility and the topic we’re going to be discussing. But if you could please introduce yourself to begin with, then we’ve got some excellent questions that our community would like to hear more about. 

And as I mentioned, if anyone has any questions for Dr. Chu while we’re chatting, please don’t hesitate to ask.

Dr. Chu

Okay, good afternoon everyone, and Eloise, thank you very much for having us on. It’s a really important topic that we’re about to discuss. As you mentioned, my name is Justin Chu. I am the Medical Director and an IVF consultant by trade at TFP Oxford, which is a big unit just outside the city centre.

Eloise Edington

Excellent. We’d like to talk to you today, being October and Baby Loss Awareness Month, about miscarriage, but also about miscarriage if you have conceived with donor eggs, which is specific but affects a lot of people. 

I know that at TFP Fertility, you help a lot of people with donor conception. I have donor-conceived children, and I have also experienced a miscarriage or chemical pregnancy with donor conception, so this is really a topic close to my heart as well. 

I’m going to begin by asking: how common are miscarriages with donor eggs?

Dr. Chu

Yeah, I think that’s a really good place to start. The first thing to say is that, unfortunately, with any IVF treatment—whether we’re using the patient’s own eggs or donor eggs—there is always going to be a risk of miscarriage. 

A miscarriage can be caused by a number of different things, but the vast majority are actually caused by a genetic issue within the embryo. 

Clearly, if you are a woman who is a little bit older and you opt for the use of donor eggs, the risk of miscarriage should, in theory, follow the age of the egg donor, which would, I presume, normally be on the younger side.

Eloise Edington

That’s it.

Dr. Chu

Most groups will have an age cut-off. At TFP, that would be 35. We want to see our egg donors before they turn 35, so that we know the egg quality should be better. 

But I suppose the key thing is to also understand that, unfortunately, with donor egg treatment, there is still a risk that the eggs used to create that embryo may have a slightly abnormal number of chromosomes, which can potentially cause a miscarriage later on.

Eloise Edington

This leads me to ask: with a donor egg cycle, would you typically do PGT (preimplantation genetic testing)?

Dr. Chu

Actually, we don’t typically do that. What we tend to do is speak to patients about their options. 

There is the potential of running PGT-A, as you mentioned, to screen the embryos to make sure they have the normal 46 chromosomes before we transfer. I suppose that’s like an added assurance. 

Yes, we can offer it, but we wouldn’t necessarily recommend it because the whole point of, let’s say, a woman with poor egg reserve or poor egg quality opting for donor eggs is to get around that issue anyway.

Eloise Edington

That makes complete sense. As I said before, if anyone has any questions on fertility treatment, miscarriage, or donor eggs, please don’t hesitate to ask. You can also follow up with the team afterwards — I’ve linked up TFP Fertility’s website in our bio. 

So with a donor egg pregnancy is there any reason why it would be higher risk than any other pregnancy? 

Dr. Chu

No, it shouldn’t be. I still lead up the Tommy’s Clinic, and unfortunately, with any pregnancy, there is always a risk of miscarriage—around one in three or one in four. So, with a donor egg embryo, it should be roughly the same risk as a naturally conceived pregnancy.

Eloise Edington

That’s good to know. Are there any symptoms that you should watch for, and any specific symptoms or time scales following a donor egg conception or IVF journey?

Dr. Chu

Yeah, so the commonest early pregnancy symptoms that we see when, unfortunately, a patient is just starting a miscarriage will be pain and bleeding. 

Characteristically, there’ll be crampy lower abdominal pain, and then bleeding. It can be quite light bleeding or heavy bleeding, but I think if you experience those symptoms, the first thing to do is contact the fertility unit that you’re having treatment with, just to get advice.

Eloise Edington

There sadly isn’t a lot that you can do in the early weeks if this happens, is there?

Dr. Chu

No, unfortunately not. So, in those situations, we generally assess people over the phone if it’s out of hours, but obviously, if it’s during office hours, we may well ask you to come into the IVF unit so that we can actually assess you from a clinical perspective. We’ll take a quick history, maybe examine you, and perform an ultrasound scan on the pelvis if it’s appropriate, and then we would provide advice. 

But you’re absolutely right, unfortunately, there isn’t anything we can do to necessarily curtail a miscarriage or rescue it, per se.

Eloise Edington

I guess, in terms of—this is a question for people who might be exploring donor eggs currently or in the future—in terms of what happens after your transfer, would a woman be given additional progesterone to try to reduce the risk of miscarriage?

Dr. Chu

Yeah, so I mean, this is a real hot topic, and there have been some really big trials done in this area in terms of progesterone use before or just after embryo transfer. There isn’t really conclusive evidence as to the best strategy we should be using. 

Clearly, if you’ve had a previous history of miscarriage, this is something that we’d want to talk to you about when we’re planning out an embryo transfer or synchronous donor egg transfer cycle that we’d organize.

Eloise Edington

Thank you. I’d also love to know, what are the sort of time scales you might be looking out for, in terms of symptoms, following a donor egg transfer?

Dr. Chu

Yeah, so after any embryo transfer, it’s quite common to get a little bit of spotting. Where we’ve scratched the canal of the neck of the womb to actually do the embryo transfer, sometimes that can disturb a couple of very small blood vessels in the cervix, and that can cause some spotting right after the embryo transfer. 

Hopefully, if we’ve been really skillful in the embryo transfer, you might not have any bleeding whatsoever, but it’s not really something we can necessarily control.

Now, clearly, if you do get some bleeding before your pregnancy test, and if it’s light, that could signify a bit of implantation—so the actual embryo latching onto the lining of the womb. After that, a few days after the embryo transfer, if we get some bleeding, sometimes (not always), that can signify what we would call a biochemical pregnancy loss. 

And obviously, if you’ve had a positive pregnancy test and then bleeding, that would again be called a biochemical pregnancy loss. Similarly, even after that seven-week scan that we do a few weeks after the embryo transfer, if there’s bleeding or pain, again that could signify miscarriage.

So the timing really is very unpredictable. If miscarriage is going to happen, it depends on how far along the process the embryo has implanted and when it ends up miscarrying.

Eloise Edington

It can be very confusing, can’t it? I know, having been a patient, on the one hand, you want to see implantation bleeding or what you think might be something to show that the transfer has worked, but then if you do get that, there’s a concern that it could be a loss. 

So if you do get it, there’s worry, but if you don’t, you might also be concerned. It’s really good to hear how everybody is different, to try not to read into these symptoms after a cycle, prior to knowing really what’s going on.

Dr. Chu

Yeah, I fully agree with you. I think, as you mentioned, everyone is different. Unfortunately, miscarriages are going to happen after fertility treatment, and again, there’s not very much we can do to absolutely eliminate that risk. 

If you are experiencing symptoms of pain or bleeding after an embryo transfer, whether that’s with your own egg embryos or donor egg embryos, I think it’s really important to just get in touch with the IVF unit you’re under so that we can actually provide you with the advice that would hopefully reassure you but also set you on the right management path as well.

Eloise Edington

How do you manage this process at TFP Fertility, in terms of if someone has concerns or any of the symptoms we’ve just been discussing, and it’s early on? 

You mentioned you’d want them to come in and see you right away. Is that the standard protocol you would suggest or recommend?

Dr. Chu

Yeah, absolutely. Obviously, if patients are alarmed by any symptoms, they’ll get in touch with us by telephone first of all. There will always be an offer of a review, even if it might not necessarily be beneficial, because I think that TLC—that compassionate care—is really vitally important. That’s what we stand by at TFP as well. 

If we do invite someone in, we take a quick history about what’s been happening, and then perhaps an examination may be required, and also an ultrasound scan if it’s further down the line where we might be expecting to see something on the ultrasound scan. If it’s too early, doing an ultrasound scan isn’t necessarily going to be beneficial, but we would explain that in the clinical assessment first.

Now, clearly, if someone has had a positive pregnancy test and they’ve come in for their seven-week clinical pregnancy scan and we find that, unfortunately, there’s an empty gestational sac or an empty pregnancy sac, then we may need to do some confirmatory scanning—maybe a week down the line, a few days down the line, or get another sonographer to scan as well to ensure that we can confirm the diagnosis of miscarriage. 

Obviously, providing that compassionate care is part of what we do here, but in that scenario, we would also look to use our really close colleagues within the NHS Early Pregnancy Unit so that you can go on to the right management pathway as well.

Eloise Edington

That’s really good to know. Would it be normal practice to transfer one embryo with a donor egg cycle?

Dr. Chu

It would be, purely because with a donor egg embryo, what we’re basically saying is that by using a donor egg, we are optimizing the chances of pregnancy. 

By increasing the number of embryos we’re putting back, in effect, all we’d be doing is increasing the chances of a multiple pregnancy. Ironically, the risks of miscarriage actually increase with a multiple pregnancy as well.

Eloise Edington

What’s the reason for that?

Dr. Chu

Well, I think it’s just that it isn’t necessarily normal physiology to have a multiple pregnancy, so the risks of most things that can happen in obstetrics and gynecology—in early pregnancy and also later pregnancy complications—tend to increase if there’s going to be a multiple pregnancy inside the womb.

Eloise Edington

Makes sense. Fascinating. Thank you so much for sharing all of this today. We’ve just talked about next steps in the clinic if anyone is concerned, and also, as you mentioned, depending on the gestation and where you’ve got to in the pregnancy, how that fits in with your NHS care or your OB-GYN, for example. 

If this sadly happens and you’re regrouping on next steps, as a medical director, what would you look at in your patients’ records? Tell us a bit more about what those next steps look like.

Dr. Chu

The first thing’s first—I think it’s important that if a miscarriage has been diagnosed, it gets managed properly, and that’s where we wouldn’t just refer on. We would provide that additional support from our IVF unit as well. That’s the first thing to say. 

Once you’re into an NHS Early Pregnancy Assessment Unit, they will offer a set of options to manage the miscarriage. It could be that we allow for nature to take its course by doing expectant management. Sometimes the gynecology team will offer some medicine or tablets to help the miscarriage episode complete. 

Then lastly, of course, there’s always the option of doing an operation—a surgical management of miscarriage to end the miscarriage episode.

I think really commonly, patients at that stage need some follow-up.

Eloise Edington

Of course.

Dr. Chu

So, that follow-up can be with the Early Pregnancy Assessment Unit if they’ve got the provision and resources to provide that post-miscarriage care. Unfortunately, a lot of the Early Pregnancy Assessment Units really struggle with that. They’re definitely working really, really hard to provide that care, but because the NHS is so busy, they often can’t. 

In that scenario, what we tend to tell our patients is to let us know when they’re ready to come back into the clinic, answer your questions in a bit more detail, and we would review the notes, look at exactly what happened in the cycle, examine the egg reserve of the donor, and see how many eggs were actually collected in that cycle. 

We would look at embryo progression as well—how the embryo developed within the laboratory—to give us a clue as to why this miscarriage happened. We’d also look at the grade of the blastocyst that was transferred. Then, we would want to look at all of that information and speak to the patient about potential causes.

Now, if there are multiple miscarriages that have happened, we may need to think outside the box. It’s not always a genetic problem, so do we need to do some further testing to look for things like sticky blood disorders or thyroid problems? We might also look at genetic testing in the female or male patient to understand more about what might have happened. It’s not always the case that we’ll order lots of tests, but sometimes we’ll look at those notes and try to discern what testing makes sense in this scenario.

Eloise Edington

I guess having a focus and being able to investigate means that you can come up with a plan if people wish to try again, and regroup on next steps depending on where they’re at. But also, emotionally, it would be interesting to hear how you support your patients when this happens.

Dr. Chu

Yeah, so I think, first of all, as the IVF unit, if we’ve caused the pregnancy that’s unfortunately miscarried, we’re there with an open line and the offer of a review whenever the patients require it. 

Obviously, we’ve got counselors in-house as well, who can provide some excellent support. They are a fantastic team. Sometimes, patients struggle to speak to doctors in every scenario, so they may benefit from speaking to another type of healthcare professional, like a counselor, about the difficulties they’ve had since the miscarriage.

Just a couple of plugs as well—there are brilliant charities out there like Tommy’s and the Miscarriage Association, who can also offer support. So, there’s lots of information out there, and the important thing for patients to know is that they’re not alone. Lots of patients go through miscarriage, unfortunately, and often it’s nothing that they’ve done.

Eloise Edington

Exactly, yeah, 100%. And I think that’s it—having that community so you can speak to other people who may have experienced the same thing. 

It’s really interesting when I talk to friends, people in the community, or family about having a chemical pregnancy—it’s amazing how many people say they’ve also experienced a miscarriage. You may never have known that because not everyone talks about it, so it’s great to have people you can turn to if you need that support, whether it’s professional or loved ones.

Someone has just asked a question—I want to ask if that’s okay. This is a great question: what counts as multiple pregnancy loss? If a patient has had two chemical pregnancies not using a donor, when would PGT be appropriate?

Dr. Chu

Yeah, I think that’s a really good question and another hot topic of debate. There are lots of different bodies that offer guidance on how we should manage recurrent pregnancy loss. The Royal College of Obstetricians and Gynecologists has it as three miscarriages—they previously used to define it as consecutive miscarriages. 

Tommy’s itself would consider it as two previous miscarriages, and similarly, European bodies have a slightly different view too. So, it’s really difficult. I think, within the context of a patient, you then have to decide how likely it is that there’s a reversible cause of miscarriage that we might identify by doing some testing. If tests are going to cost money, potentially cause health anxiety, and slightly change the direction for a patient, then we need to be very careful about which tests we offer.

At TFP, what we tend to do is speak to those patients, find out more about them, and ascertain whether we think the testing would be of benefit. 

In terms of the PGT question, that’s a really great question to ask, and again, sorry to be vague, but it’s going to really depend on if you’re using a donor, how many miscarriages there have been, what was the age of the donor, can we find out a little bit about their own obstetric history, and how likely is it that we could be missing another genetic reason. 

But also, it depends on how tough it’s actually been for the recipient couple. If the recipient couple have one miscarriage and they’re like, “We don’t ever want to go through that again,” then there is potentially a role for PGT-A in that too.

Again, sorry to be vague and not tied down to an answer, but it really depends on the clinical context. It’s case by case in terms of what you’d recommend and what you’d look at, which is great because it’s that personalized approach to getting the patient, and the person you’re caring for, to where they want to be and getting the outcome that they want, that we want.

Eloise Edington

In terms of regrouping, if a patient wants to try again, what would timelines look like depending on where they’re at emotionally?

Dr. Chu

I think from an emotional perspective, what we tend to see is that patients might be ready two to three months after a miscarriage event. 

When you think about the lining of the womb, we obviously want the miscarriage to have happened, but we also want the new endometrium that forms—though it might still be a bit heavy and might still have some residual tissue—that might not necessarily be conducive to implantation. 

Those things kind of marry up in terms of getting through the emotional stress of the miscarriage episode but also ensuring that we’re back to having nice, normal, regular periods.

Eloise Edington

That makes complete sense. Again, if anyone has any questions for Dr. Chu, please feel free to ask. I’ve linked up the TFP website in our bio, so please do reach out to the team, who are very happy to help you with your personal needs and to book a consult.

What would your advice be in terms of using the same donor if there had been a loss with donor eggs and it was your first loss, for example, using that donor? Would that be different in terms of looking at whether you might use a different donor compared to if there had been multiple losses with the same egg donor?

Dr. Chu

In the first situation, if you’ve had one loss, because you can have sporadic issues from a genetic perspective from any egg that we use to create an embryo, I think it would be quite a reflex reaction—knee-jerk, almost—to say, “Well, I need to use a different donor.” I would certainly pause because there are going to be really good reasons that a couple or a woman has chosen to use that egg donor, and that will have been thought out long before the miscarriage actually happens. Now, clearly, if there have been multiple miscarriages, that’s when a woman may lose a little bit of trust in the embryos that are there, and it’s definitely worthwhile having that discussion and reasoning it out. Again, it’s going to really depend on the embryos that are still in storage that might be suitable for frozen embryo transfer.

Eloise Edington

We have had another question. Speaking of residual tissue, how long does the benefit of an endometrial scratch last? 

Dr. Chu

Well, I think, again, just to be really clear, there’s still a lot of debate about whether endometrial scratching is of real benefit for helping embryo implantation.

I think that as we’re learning more and doing more PGT, it’s becoming very clear that the competency of the embryo—the genetic makeup of that embryo—is actually a really important part of whether someone gets pregnant or not. Whereas, obviously, an endometrial scratch is really looking at trying to cause a slight immune reaction within that endometrial cavity to aid implantation. The difficulty is, after you’ve done a scratch, the lining of the womb completely regenerates again. And that’s where some of the critics of endometrial scratch have pointed to—how would it still be of benefit in cycles after, because the endometrium is going to regenerate every single month and will look very different? That’s exactly what it’s designed to do.

Eloise Edington

Really interesting. Thank you so much. I hope that clarifies that for the person who asked. Another question: what is the evidence around NK testing in recurrent miscarriage?

Dr. Chu

Yeah, really good question, and again, it links up really nicely with my Tommy’s work. Within Tommy’s, there’s still a lot of research going on about natural killer cell testing within the uterus. I think we need to go back a step and acknowledge that with the PGT data we have, embryo competency is very important. But absolutely, there will be a small subset of patients who could benefit from some immune tests from the womb cavity itself. There is still a part to play, possibly with endometrial scratching and NK cell testing as well, within the womb cavity.

Eloise Edington

Fascinating. Well, Dr. Chu, this has been really helpful. I hope it’s helped everyone else—no doubt it has. Any final advice you’d give to anyone contemplating donor egg conception or someone who has sadly had a miscarriage that you would give to people at this stage?

Dr. Chu

Yeah, so firstly, for someone considering donor egg treatment, I really think that part of our job as IVF consultants, when we’re seeing patients, is to be really open, frank, and clear with patients about what kind of treatment we need to do. 

That’s exactly what TFP goes by—it’s the real mantra behind all the consultations we do. We’re very open and honest, and clear about what treatments patients should consider.

Now, the consideration for using donor eggs is often difficult. Some couples are quite happy to make that decision quickly and early on if using their own eggs isn’t proving fruitful, but other couples need a little more time. It’s our job to support them and offer those options as we see them as appropriate. 

The last thing about miscarriage as an outcome from any fertility treatment is that often I tend to find that the patients who unfortunately have a miscarriage have a really rough deal because it’s almost like an extra loop, isn’t it, on the fertility roller coaster journey that they’re going through? 

So again, we try to offer as much support as we can because we know how tough that journey is, and having that extra loop of having a positive test and then it not working out is really tough. 

So often that TLC, that support, and the counseling help are really important.

Eloise Edington

Absolutely. Well, all the holistic support you provide at TFP Fertility is amazing, and I would urge anyone to click our link in bio to find out more and start having that conversation with the team today, who would love to help you. 

I think that’s a really important thing to close on. Having been there myself—not egg donation, but sperm donation—having to take that leap into the donor conception realm, I guess it’s really hard with your own eggs, and I presume you see lots of patients who may have had multiple miscarriages using their own eggs to get to the stage of considering egg donation, and it’s kind of when might they start to think about that as a treatment option? So, of course, you’re well-versed when it comes to considerations from a medical standpoint, but also at what point in people’s fertility journey might they be interested in speaking about it as an alternative route to family building, as well.

Dr. Chu

That’s exactly right.

Eloise Edington

Well, thank you very much for your time. I know you have patients to see, so I really appreciate you coming on live with us and answering these fantastic questions. And thank you to everyone who joined today. Do reach out to the team.

Okay, thank you guys very much. Bye-bye.

Dr. Chu

Bye.