miscarriage

Infertility can be a challenging journey, especially when miscarriage happens. For those who have experienced pregnancy loss or failed IVF, your doctor may have brought up the use of donor eggs. Egg donation is when a woman who is medically cleared donates her eggs to be used by another woman (or gestational carrier) who cannot conceive with her own eggs. You may be wondering whether donor eggs can decrease the risk of miscarriage and increase your chances of bringing home a healthy baby. In this article, we’ll lay it all out.

Why do miscarriages happen in the first place?

Miscarriage, also known as pregnancy loss, is a devastating experience. It occurs when a pregnancy ends on its own before the 20th week of gestation. Miscarriage can happen to anyone, and it's estimated that up to 20% of pregnancies end in miscarriage. When a family suffers two or more pregnancy losses, it is called recurrent miscarriage.

There are many reasons why miscarriage can occur, and in most cases, it's difficult to pinpoint a specific cause. Here are some common reasons why miscarriage happens:

• Chromosomal abnormalities: The most common cause of miscarriage is chromosomal abnormalities. This means that the fetus has an abnormal number of chromosomes or a structural problem with a chromosome. These abnormalities are usually random events and not related to anything the parents did or did not do.
• Infections: Infections during pregnancy can cause miscarriage, especially if left untreated. Infections such as rubella, cytomegalovirus (CMV), and toxoplasmosis can be harmful to a developing fetus.
• Structural issues: Structural issues with the uterus or cervix can lead to miscarriage. For example, if the cervix is weak or incompetent, it may not be able to support the weight of the growing fetus, leading to premature delivery or miscarriage. Uterine anomalies, such as a uterine septum, can also increase the risk of miscarriage. 
• Autoimmune problems: An overactive autoimmune system can mistake the fetus as a foreign object and attack it, causing miscarriage.
• Lifestyle factors: Certain lifestyle factors can increase the risk of miscarriage. These include smoking, alcohol use, and drug abuse. 

Unfortunately in most cases, the exact cause of miscarriage is unknown, and it's not always possible to prevent it from happening. Read more about the common causes of miscarriage. 

What is the risk of miscarriage with donor eggs?

The short answer is that using donor eggs decreases the risk of miscarriage for most women. Especially when those miscarriages were due to chromosomal abnormalities. Because egg donors are young (under 33) and medically cleared, outcomes with donor eggs are better than outcomes with a patient’s own eggs. 

Women who use donor eggs tend to be older, and age is a significant factor in miscarriage risk. As women age, the quality of their eggs decreases, and the risk of chromosomal abnormalities increases, which can lead to miscarriage. By using younger, healthier eggs from a donor, the risk of chromosomal abnormalities is significantly reduced.

Furthermore, the donor egg IVF process involves extensive screening of the donor to ensure that she is in good health and has a low risk of genetic disorders. This can further reduce the risk of miscarriage, as genetic disorders can be a significant contributor to pregnancy loss.

What does the research say?

There is a paucity of research on donor eggs. But one 1997 study of 418 embryo transfer cycles among 276 egg donor recipients at one clinic found that:

• 36.2% got pregnant on the first try with donor eggs, and 29.3% had a live birth
• 87.9% got pregnant within four cycles and 86.1% had a live birth

This data did not differ for women of various ages of diagnoses. Another study from 1998 found that the miscarriage rate for donor eggs was 7.2% for women under 45 and 16.1% for women 45-50. 

However, because these studies were 25+ years ago, and each included outcomes data from a single clinic, we can take it with a grain of salt. We’ve had incredible progress in fertility treatments over the last 25 years, including ICSI and PGT testing,  and one would hope for even better outcomes today. 

Why do donor eggs miscarry?

Donor eggs miscarry for some of the same reasons any pregnancy ends in loss. There could be implantation issues, or issues with the lining of the uterus or other factors that make implantation more difficult, increasing the risk of miscarriage. Or there could be other health issues such as hormonal imbalances, autoimmune problems, or structural problems like fibroids. Of course, there’s also just chance / luck which is sometimes not on our side. 

While donor eggs can reduce the risk of certain fertility-related issues, it does not eliminate the risk of miscarriage entirely. Miscarriages are common, and it's important to work with your doctor to understand the potential risks and to receive appropriate care throughout the pregnancy.

How to reduce the risk of miscarriage with donor eggs

We recommend adopting a relaxed lifestyle and moderating physical activity after an embryo transfer. The most important factor in predicting successful implantation is the quality of the embryo and the optimal hormone environment in the uterus. After the transfer, the most important thing you can do is to take your medications as prescribed. You can rest assure that no other external factors will impact the outcome of your cycle (ie. high stress, specific foods, bumping your abdomen against a hard surface). If you have any problems with the injections, let your clinical team know as soon as possible.

Are donor egg pregnancies high risk?

Donor egg pregnancies may be higher risk, but more research is needed. One meta-analysis of 11 studies found: 

• The risk of developing hypertensive disorders is nearly 4X higher for donor egg pregnancies
• The risk of having a cesarean section is 2.71X higher for donor egg pregnancies
• Preterm delivery is 1.34X more likely with donor egg pregnancies

Another study from Columbia University found that age doesn’t impact risk of complications, and that both older and younger women had similar rates of gestational hypertension, diabetes, cesarean delivery, and premature birth. When undergoing IVF, your doctor will give you an idea of your specific health risks and how to help reduce the risk of complications.

What is the success rate of IVF with donor eggs?

Here’s some good news: donor eggs can drastically increase your chances of success! Around 53 percent of all donor egg cycles will result in at least one live birth. This percentage varies depending on the egg donor, recipient body mass index, stage of embryo at transfer, the number of oocytes retrieved, and the quality of the clinic.

At every age, the chances of birth with donor eggs is better, but those who benefit the most from donor eggs are women over 35 and those with low ovarian reserve. In fact, about one-quarter of women over 40 who succeeded with IVF did so through the use of donor eggs.

At Cofertility, for those who match with a donor in our fresh egg donation program, the average number of mature eggs a family receives and fertilizes is 12. The number of eggs retrieved varies by patient and cycle, but can be predicted by a donor’s age, AMH, and antral follicle count, all of which will be known to you after the donor’s initial screening. Qualified candidates have an ample ovarian reserve for both their own needs and sharing. Egg share donors also often work closely with a fertility doctor to determine, based on their own medical history, the optimal number of eggs needed for their own future family-building goals. Should it make sense for the donor, they may choose to pursue a second egg-sharing cycle to maximize the chances of success for everyone.

Matching with a donor in our frozen program can provide the opportunity to move forward with your family-building plans faster, as frozen eggs can be fertilized or shipped to your clinic immediately or as soon as the cycle is complete. Donors undergoing frozen cycles complete equally rigorous ovarian reserve testing. While the total number of frozen eggs available will vary based on the donor’s retrieval outcomes, every frozen match is guaranteed to have a minimum of at least 6 frozen eggs.

To learn more about these programs and the differences between them, click here.

Ready to move forward with donor eggs? We can help!

Cofertility is a human-first fertility ecosystem rewriting the egg freezing and egg donation experience. Our Family by Co platform serves as a more transparent, ethical egg donor matching platform. We are obsessed with improving the family-building journey — today or in the future — and are in an endless pursuit to make these experiences more positive. Create a free account today!

Gestational surrogacy involves a woman agreeing to carry and give birth to a baby for someone else. After the baby is born, the gestational carrier (GC) gives custody and guardianship to the intended parent or parents via a legal document. This document states that the baby is not hers and that she has zero claim over the baby and surrenders all rights. The baby may have all, partial or none of the DNA from the intended parents. Due to medical reasons, carrying your own baby may not be a possibility and that may create some very strong negative feelings. Feelings of guilt, anger, loss and failure are very common. 

The grief of not carrying your child

Grief is something that is experienced after a deep and meaningful loss. We usually think of grief in terms of a death. However, grief in surrogacy is also very real, as the death of the dream of having and carrying a child of your own, may no longer be a reality. 

During the surrogacy process, grief can be felt after failed IVF attempts or miscarriages. There may be grief about the loss of a biological connection if donor gametes need to be used. There may be grief about missing out on the pregnancy milestones such as feeling the baby kick. There may even be anticipatory grief of believing that one may be unable to bond with the baby after birth. 

Stages of grief and how they manifest

Grief during surrogacy can manifest itself in many ways. It doesn’t always manifest as sadness as we would expect. During surrogacy, the intended parent(s) may go through stages of denial, anger, depression, and even guilt. 

Denial

Denial is typically the first way grief manifests during surrogacy.  Unless you have always known that you will not be able to carry your own child, that realization that you will not be carrying and birthing your own child, can be a difficult pill to swallow. Because you may look or feel healthy, you may not believe what you are being told.  You may refuse to believe that this is true. 

Anger

Anger can be aimed at self, partners or doctors. Even at random pregnant women walking down the street. Since this all seems very unfair, you may be easily set off by the most minor things. Your reactions may vary from minor irritability to intense rage. 

Depression

When the sadness just doesn’t go away. When it becomes more and more difficult to engage with life, depression may be setting in. There may be a sense of hopelessness and a loss of interest in things that used to create joy and happiness. There may be sleep issues - too much sleep or not sleeping at all. There may be a lack of appetite and social isolation. 

Guilt

Surrogacy guilt is real. The feeling that it is your fault and that maybe you are a bad person or are doing something wrong can start to appear as you go through a surrogacy. It may manifest as embarrassment, shame or a sense of inferiority. 

It is important to understand that all these feelings and emotions are normal. It is also important to understand that with the right help, these feelings can be processed and managed. You can get to the other side. 

How to deal with questions from nosy people

Sometimes questions that we consider to be personal are unavoidable. If you are using a gestational carrier to have a baby and you ask for maternity leave or tell people you are expecting when you’re not visibly pregnant, you can only expect people to be curious.

Luckily you have options. You are never obligated to tell anyone anything. It is afterall a personal matter and you are in charge of who gets to know what information. You can decide to share and tell your story while leaving out some information. You can do this by crafting an answer that you feel comfortable with. Write out some answers and start testing them - how does it feel when you say it? 

Coping strategies

The path through grief is winding and often disorienting. But equipped with coping strategies and the validation that your emotions are to be honored, not ignored, you are better poised to traverse this emotional landscape. Here are some coping strategies to try:

Find support through counseling or support groups

Navigating the emotions when using a gestational carrier often necessitates external assistance for emotional equilibrium. The act of consulting a therapist or joining a support group can serve as a respite from the mental weight one is carrying. Therapeutic interventions have been shown to improve emotional well-being and reduce symptoms of depression and anxiety). In the company of a trained therapist or a community of people sharing similar experiences, you are granted the space to explore your emotions and thoughts candidly. The collective wisdom found in these gatherings might provide unanticipated insights or coping strategies that you hadn't previously considered.

Communicate with your partner, friends, or loved ones

Solitude might offer a temporary refuge, but enduring support often lies in meaningful dialogues with those who share your life. Quality communication fosters emotional intimacy and provides a backdrop against which you can more fully understand your own feelings and concerns. By confiding in someone you trust, you externalize your emotions, creating room for insight and understanding to settle in.

Spend time with people you love

In the abyss of grief, companionship can be a lifeline. While the impulse to isolate may be strong, seclusion seldom serves the healing process. Human interaction releases oxytocin, a hormone proven to reduce stress and create feelings of well-being. Time spent with loved ones offers a reprieve, however brief, from the emotional turmoil you're enduring.

Spend time doing things you love

When enshrouded in grief, it's all too easy to forget the activities that once elicited joy. Though it may require a conscious effort, engaging in a beloved pastime can redirect focus and uplift spirits. Whether it's reading a treasured book or painting a canvas, these activities serve as emotional anchors, grounding you in a reality that still contains elements of pleasure and fulfillment.

Listen to your body

Grief can be visceral, a physical ache that demands your attention. If you feel the urge to cry, let the tears come. Emotional tears have been found to contain stress hormones and are thought to be a way for the body to achieve emotional release. Denying your body's signals to grieve can delay healing, whereas acknowledging them can pave the way for emotional relief.

Give yourself compassion

Self-compassion is not merely an emotional indulgence but a psychological necessity. Self-compassion is often linked to better mental health outcomes and resilience. It provides you with the psychological space to accept your feelings without judgment. Offering yourself compassion means acknowledging that grief is an inherently human experience, worthy of patience and understanding.

Keep a journal

Writing down your thoughts and feelings is akin to speaking them out loud but in a more introspective manner. By committing your feelings to paper, you're not only creating an emotional release valve but also establishing a written record that can help you track your emotional journey and healing progress over time.

Maintain a healthy lifestyle

A robust mind is often housed in a robust body. Regular exercise, balanced nutrition, and adequate sleep can have a profound effect on emotional health. It may be tempting to neglect these basics when grief strikes, but maintaining a healthy lifestyle provides the physiological support needed to cope effectively with emotional strain.

As you journey through, remember, the path is not to be walked alone. Seek and extend support; empathy and understanding are companions you need not leave behind.

Conclusion

Surrogacy can be an emotionally challenging journey. One fraught with many ups and downs. Aside from the complex medical procedures and legalities and costs, there needs to be an acknowledgement of the grief that also accompanies the process. 

Seeking support and resources before embarking on the journey, during and even after are important to managing emotions and the psychological impact of surrogacy. So prioritizing support is vital for the well-being of everyone involved. Cofertility is here to guide you every step of the way. 

Read more:

• What Should I Know Before I Get Serious About Surrogacy?
• Can Someone Break Down the Costs of Surrogacy?
• What Do I Need to Know About Surrogacy Laws?