Miscarriage After IVF: Risk, Causes and Chances of a Successful Pregnancy

Miscarriage risk after IVF is driven mainly by maternal age, the chromosome status of the embryo and existing health conditions rather than by the IVF procedure itself. Early pregnancy loss occurs in about 10% of all clinically recognised pregnancies, and the rate rises steeply with age.[1] When maternal age and other characteristics are accounted for, studies comparing IVF and non-IVF pregnancies find no independent effect of IVF on first-trimester outcome.[2][3] Your own risk depends on your history, and only a specialist who has reviewed it can estimate it for you.

Written by: Diana Lobzeva, MD, Senior Director of International Medical Affairs, OBGYN, Reproductive Endocrinologist

Medically reviewed by: Nikolay Kornilov, MD, Medical Director, Reproductive Medicine

Published: 9 September 2025 · Updated: 29 July 2026

Last medically reviewed: 29 July 2026

Medical disclaimer

This article is intended for educational purposes and does not replace individual medical advice, diagnosis or treatment provided by a qualified healthcare professional.

Seek urgent medical care if you experience severe pain, heavy bleeding, fainting or other concerning symptoms.

Key Takeaways

After adjustment for maternal age and other characteristics, IVF has no independent effect on the risk of first-trimester loss.[2][3]
Around half of early pregnancy losses are caused by chromosomal abnormalities in the embryo.[1]
Maternal age is the strongest risk factor: clinically recognised loss rises from 9–17% at ages 20–30 to about 40% at 40.[1]
Most published percentages describe groups, not individuals, and should not be applied directly to one person.
Heavy bleeding, severe or one-sided pain, shoulder-tip pain, fainting or fever need prompt medical assessment.[11]

What Is the Risk of Miscarriage After IVF?
What Is Considered a Miscarriage?
What Causes Miscarriage After IVF?
How Miscarriage Risk Changes With Age
Can Anything Lower the Risk?
How Risk Is Assessed at NGC
After a Pregnancy Loss: What Testing May Be Considered
When to Seek Urgent Medical Care
What You Can Discuss With Your Doctor
Summary

What Is the Risk of Miscarriage After IVF?

Early pregnancy loss occurs in about 10% of all clinically recognised pregnancies, and roughly 80% of losses happen in the first trimester.[1] Estimates across guidelines range from about 10% to 15% depending on how loss is counted.[14]

Crude figures for IVF pregnancies often look higher than general-population figures, and this is a real observation — but it reflects who is being treated rather than the treatment. A 30-year analysis of 16,458 pregnancies with confirmed first-trimester outcomes found an overall loss rate of 20.3%, higher in IVF pregnancies and in women aged 35 and over. However, once maternal age and vaginal bleeding were controlled for in logistic regression, the mode of conception had no independent effect on outcome; the authors concluded that a woman pregnant via IVF has the same likelihood of miscarriage as a comparable woman with a non-IVF pregnancy.[2]

A Danish cohort of women with an ultrasound-verified viable pregnancy at 6–8 weeks reached the same conclusion: after adjustment for maternal characteristics, none of the fertility treatment types were associated with an increased risk of miscarriage compared with women conceiving naturally. The overall miscarriage rate in that cohort was 11.8%, and 94.9% of losses occurred before the 11–14-week scan.[3]

Two practical consequences follow. First, a single population percentage cannot tell you your own risk. Second, most of the factors that matter are identifiable before transfer, during the diagnostic work-up — which makes a thorough pre-treatment assessment more informative than any published average.

What Is Considered a Miscarriage?

There is no single international definition, and clinical guidance says so explicitly. In the first trimester the terms miscarriage, spontaneous abortion and early pregnancy loss are used interchangeably, and there is no consensus on terminology in the literature.[1]

US clinical guidance defines early pregnancy loss as a nonviable intrauterine pregnancy with either an empty gestational sac, or a gestational sac containing an embryo or fetus without cardiac activity, within the first 12 6/7 weeks of gestation.[1] For later losses the gestational limit differs by region: European guidance on recurrent pregnancy loss counts losses before 24 weeks, while American and Australasian guidance uses 20 weeks.[4][14]

This matters when comparing statistics — figures built on different cut-offs are not directly comparable.

Terms that are often confused with miscarriage

Biochemical (chemical) pregnancy — a positive hCG test that never progresses to a gestational sac visible on ultrasound. Because figures based on clinical pregnancies exclude these very early losses, they are lower than figures that include them.

Ectopic pregnancy — an embryo that implants outside the uterine cavity. It is not a miscarriage, and it requires urgent assessment.[11]

Clinical guidance treats these as separate diagnostic pathways: guidance on the management of intrauterine early pregnancy loss explicitly excludes ectopic pregnancy, pregnancy of unknown location and recurrent pregnancy loss from its scope, and cautions that incorrectly diagnosing a pregnancy loss increases the risk of harming a live, normally sited pregnancy.[13] This is why the diagnosis rests on defined ultrasound criteria rather than on symptoms or a single hormone measurement.

What Causes Miscarriage After IVF?

It is important to separate an established cause from an associated risk factor, and both from interventions with an uncertain evidence base. Presenting a risk factor as a direct cause is one of the most common errors in patient-facing material on this topic.

Established causes

Chromosomal abnormalities in the embryo. Approximately 50% of early pregnancy losses are caused by fetal chromosomal abnormalities.[1] These arise at conception and are not caused by anything the patient did or did not do.

Factors associated with increased risk

Maternal age and a previous early pregnancy loss — the two risk factors most commonly identified in women who experience early pregnancy loss.[1]
Antiphospholipid syndrome — screening for antiphospholipid antibodies is recommended after two pregnancy losses, because identifying it allows treatment that can prevent associated complications in a subsequent pregnancy.[4][5]
Uterine factors such as a septate uterus or intrauterine adhesions, which may be treatable.[5] The state of the endometrium before transfer is addressed separately in Optimizing the Uterine Environment for Embryo Transfer.
Thyroid dysfunction and diabetes, both of which are part of the recommended work-up in recurrent loss.[5]
Modifiable factors — smoking, alcohol, caffeine intake and obesity are addressed in current management guidance.[5]

Where the evidence is weak or contested

Immune testing should not be a routine part of the recurrent pregnancy loss work-up.[5]
Screening for inherited thrombophilias should not be performed except in people with a personal history of thrombosis or a family history of inherited thrombophilia.[5]

In a substantial share of cases no cause is identified even after a full work-up, and patients are warned in advance that investigations carry a high probability of negative results.[5] That is a limitation of current medicine, not evidence that something was missed.

How Miscarriage Risk Changes With Age

The most consistently measured figures come from general obstetric guidance rather than from IVF registries.

Patient group	Figure	What was measured	Source
Age 20–30	9–17%	Clinically recognised early pregnancy loss	ACOG [1]
Age 35	~20%	Clinically recognised early pregnancy loss	ACOG [1]
Age 40	~40%	Clinically recognised early pregnancy loss	ACOG [1]
Age 45	~80%	Clinically recognised early pregnancy loss	ACOG [1]
All ages	~10%	Clinically recognised pregnancies ending in early loss	ACOG [1]
All early losses	~50%	Losses attributable to fetal chromosomal abnormality	ACOG [1]
MAR pregnancies, viable at 6–8 weeks	11.8%	Miscarriage after ultrasound-verified viability	Danish cohort [3]

How to read this table. The ACOG figures describe clinically recognised pregnancies — confirmed by ultrasound or clinical examination — in the general obstetric population, not exclusively in IVF patients. Losses occurring before clinical confirmation, including biochemical pregnancies, are not counted, so the true proportion of conceptions that do not continue is higher. Age is the woman's age at conception. The ACOG figures come from a practice bulletin issued in 2018 and reaffirmed in 2025; the Danish cohort data were collected in a national registry and published in 2019.[1][3] The Danish figure is measured from a different starting point — pregnancies already confirmed viable on ultrasound at 6–8 weeks — which is why it is lower and is not directly comparable to the rest of the table.[3] Your own probability may differ substantially depending on medical history, the cause of infertility, previous pregnancy outcomes and the chromosome status of the specific embryo transferred.

Doctor's Perspective

The question I hear most often after a loss is what the patient did wrong. In the majority of early losses the answer is nothing — the embryo carried a chromosomal abnormality that was present from conception, and no protocol adjustment would have changed that outcome. What the numbers in this article describe is a population; what I work with in the consulting room is one medical history, and those two things can differ considerably in either direction.

In practice, age tells me how likely a chromosomal cause is, and the rest of the history tells me where else to look — the uterine cavity, thyroid function, previous pregnancy outcomes. That is why a structured work-up before the next transfer is worth more than any single published percentage, and why I would rather explain the limits of what a test can tell us than offer a procedure whose benefit has not been demonstrated.

Valentina Denisova, MD, PhD · Obstetrician-Gynecologist, Fertility Specialist

View full profile

Can Anything Lower the Risk?

Several interventions are offered specifically to reduce miscarriage risk after IVF. Their evidence base varies considerably, and it is reasonable to ask any clinic which category a proposed procedure falls into.

What the Evidence Shows

Treating an identified, treatable condition — antiphospholipid syndrome, thyroid dysfunction, diabetes, a septate uterus or intrauterine adhesions — is part of recommended management.[5]
In antiphospholipid syndrome with recurrent loss, low-dose aspirin started before conception plus prophylactic heparin once an intrauterine pregnancy is confirmed is a strong recommendation supported by high-quality evidence.[5]
Lifestyle measures — reducing smoking, alcohol and caffeine, and addressing obesity — are included in current management guidance.[5]
PGT-A is rated green for reducing the chance of miscarriage for most fertility patients, meaning high-quality evidence supports that specific outcome.[8]

What Remains Uncertain

PGT-A and live birth. The same regulator rates PGT-A red for improving the chance of having a baby, and states plainly that reducing the chance of miscarriage may not necessarily increase the chance of having a baby. For older women the rating is grey — insufficient evidence.[8] The ASRM has concluded that the value of PGT-A as a routine screening test for all IVF patients has not been demonstrated,[6] and a Cochrane review of 13 trials in 2,794 patients found the evidence low to moderate in quality and insufficient to support routine clinical use.[7]
Endometrial receptivity testing is rated red for most fertility patients: moderate-to-high quality evidence indicates it may reduce treatment effectiveness.[9]
Immunological treatments. Intralipids and intravenous immunoglobulin are rated red; steroids are rated grey.[8] Immunomodulation treatments are not recommended in recurrent pregnancy loss.[5]
Platelet-rich plasma (PRP). There is insufficient evidence that intrauterine PRP improves the chance of having a baby, including for thin or refractory endometrium and repeated implantation failure.[10]

An intervention with an uncertain evidence base is not automatically inappropriate — for some patients it may still be a reasonable choice after discussion. What matters is that the uncertainty is stated before the decision, not after.

How Risk Is Assessed at NGC

Risk assessment begins before transfer rather than after a loss. As part of infertility treatment planning, a specialist reviews maternal age, previous pregnancy outcomes, endocrine status and the uterine cavity, since these are the factors that current guidance identifies as relevant to pregnancy loss.

Where a patient has experienced two or more losses, the work-up follows the investigations described above: genetic testing of gestational tissue, parental karyotyping where indicated, antiphospholipid antibody screening, thyroid and glycaemic assessment, and evaluation of the uterine cavity.

Whether to use PGT-A for 23 chromosome pairs is decided individually rather than applied routinely, and the discussion includes what the test can and cannot change — as set out in the evidence section above. The same applies to PRP therapy, which is offered only after the current state of the evidence has been explained.

Following a positive test, monitoring in the first trimester is based on early ultrasound rather than hCG levels alone, since most losses occur before the 11–14-week scan.[3]

After a Pregnancy Loss: What Testing May Be Considered

The international consensus definition of recurrent pregnancy loss is two or more pregnancy losses, which is the point at which structured investigation is usually offered.[4][14]

Depending on the situation, a specialist may discuss:

Genetic testing of gestational tissue and parental karyotyping, which can identify a chromosomal cause.[5]
Screening for antiphospholipid antibodies, recommended after two losses.[4][5]
Thyroid function and screening for diabetes.[5]
Assessment and, where indicated, treatment of uterine anomalies such as a septate uterus or adhesions.[5]
Investigation for chronic endometritis, which may respond to antibiotics.[5]
Progesterone therapy, which may be helpful particularly when started in the luteal phase.[5] How dosing is planned in a programmed cycle is covered in Progesterone Levels in Programmed Frozen Embryo Transfer Cycles.

Access to early pregnancy assessment, emotional support and close monitoring are treated as essential parts of care rather than optional extras, and empirical treatments are used cautiously because the evidence for them is limited.[5]

When to Seek Urgent Medical Care

Seek immediate medical attention if you experience:

heavy vaginal bleeding, or bleeding that is different from a normal period;[11]
pain low in your abdomen, which may come on suddenly or gradually and may be on one side only;[11]
pain in the tip of your shoulder — an unusual pain felt where the shoulder ends and the arm begins, which can be a sign of internal bleeding and needs medical advice straight away;[11]
dizziness, fainting or collapse;[11]
after ovarian stimulation: worsening abdominal swelling and pain, vomiting, extreme thirst, passing only small amounts of dark urine, or difficulty breathing — possible signs of severe ovarian hyperstimulation syndrome.[12]

These symptoms do not always indicate a serious complication, but they require prompt assessment. Shoulder-tip pain, one-sided pain and faintness are particularly associated with ectopic pregnancy, which is a medical emergency.[11]

What You Can Discuss With Your Doctor

Preparing a few specific questions makes a consultation more useful than trying to cover everything at once. You may want to ask:

Based on my age and history, what is a realistic estimate of my individual risk?
Which of my risk factors are modifiable, and which are not?
Do you recommend genetic testing of gestational tissue after a loss, and what would the result change?
For any add-on you propose, what is the expected effect on live birth rather than on transfer outcomes?
How long do you suggest waiting before the next transfer, and why?
What monitoring will I have during the first trimester?

It helps to bring previous ultrasound reports, hormone results, operative or hysteroscopy notes, and documentation of previous pregnancies or losses. Medication changes, dosages and treatment protocols should only be decided with your treating doctor.

Summary

Miscarriage after IVF is, in most cases, driven by the same factors as miscarriage in spontaneous pregnancy: the chromosome status of the embryo, maternal age and underlying medical conditions. Studies that adjust for maternal characteristics find no independent effect of the procedure itself on first-trimester outcome.[2][3]

Population percentages describe groups, not individuals. Your own risk depends on your age, medical history, previous pregnancy outcomes and findings from your diagnostic work-up, and it can be meaningfully estimated only by a specialist who has reviewed those details. If you have had a loss or are concerned about your risk, a consultation is the appropriate next step — and any heavy bleeding, severe pain or faintness during pregnancy needs prompt assessment rather than a wait-and-see approach.

Discuss Your Individual Situation With a Fertility Specialist

Treatment decisions and medical risks depend on age, health history, previous treatment and individual clinical factors. An NGC specialist can review your situation and explain the available options, starting with a free consultation. Patients travelling from abroad can also arrange travel support for international patients.

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FAQs

Does IVF increase the risk of miscarriage?

Not independently. Crude loss rates in IVF pregnancies are often higher, but this reflects the patient population rather than the procedure. In a 30-year analysis of 16,458 pregnancies, mode of conception had no independent effect on first-trimester outcome once maternal age and vaginal bleeding were accounted for.[2] A Danish cohort reached the same conclusion after adjusting for maternal characteristics.[3]

At what stage of pregnancy are you most likely to miscarry during IVF?

The first trimester. Approximately 80% of all pregnancy losses occur within the first trimester.[1] In a large cohort of pregnancies confirmed viable at 6–8 weeks, 94.9% of subsequent miscarriages occurred before the 11–14-week scan.[3] This is one reason clinics schedule early ultrasound scans rather than relying on hCG levels alone.

How does age affect the risk of miscarriage during IVF?

Age is the strongest single risk factor, because the proportion of chromosomally abnormal oocytes increases over time. Clinically recognised early pregnancy loss occurs in 9–17% of pregnancies at ages 20–30, rising to about 20% at 35, about 40% at 40 and about 80% at 45.[1] Where donor oocytes are used, the relevant age for chromosomal risk is that of the person whose eggs were used — this is the reason egg donation and embryo donation are discussed with some patients. For those planning a pregnancy later, postponed maternity programmes address the same underlying mechanism.

Can lifestyle changes reduce the risk of miscarriage during IVF?

Reducing smoking, alcohol and caffeine intake and addressing obesity are included in current management guidance for recurrent pregnancy loss, alongside screening for thyroid dysfunction and diabetes.[5] It is also worth knowing that around half of early losses are caused by chromosomal abnormalities that arise at conception and could not have been prevented.[1]

Does PGT-A prevent miscarriage?

The UK regulator rates PGT-A green for reducing the chance of miscarriage for most fertility patients, but red for improving the chance of having a baby, and states that reducing the chance of miscarriage may not necessarily increase the chance of having a baby. For older women the rating is grey — insufficient evidence.[8] The ASRM has concluded its value as a routine test for all IVF patients has not been demonstrated,[6] and a Cochrane review found the evidence insufficient to support routine use.[7] Whether PGT-A is appropriate should be discussed individually.

What should I do if I have a miscarriage after IVF?

Contact your treating clinic promptly, and seek emergency care if you have heavy bleeding, severe or one-sided abdominal pain, shoulder-tip pain, dizziness or collapse.[11] Structured investigation is generally offered after two or more losses.[4] It may include genetic testing of gestational tissue, parental karyotyping, antiphospholipid antibody screening and assessment of the uterus.[5] Emotional support and close monitoring are considered essential parts of care.[5]

References

American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstet Gynecol. 2018;132(5):e197–e207 (reaffirmed 2025). acog.org
Doubilet PM, Benson CB, Ginsburg ES. Early Pregnancy Loss Rate in In Vitro Fertilization Versus Non-IVF Pregnancies. J Ultrasound Med. 2025;44(10):1783–1788. doi:10.1002/jum.16728. PMID: 40396677.
Risk of miscarriage in women conceiving after medically assisted reproduction with an ultrasound-verified viable pregnancy at 6–8 weeks' gestation. Reprod Biomed Online. 2019. sciencedirect.com
ESHRE Guideline Group on RPL. ESHRE guideline: recurrent pregnancy loss — an update in 2022. Hum Reprod Open. 2023;2023(1):hoad002. doi:10.1093/hropen/hoad002
Society of Obstetricians and Gynaecologists of Canada. Guideline No. 464: Recurrent Pregnancy Loss. J Obstet Gynaecol Can. 2025. jogc.com
Practice Committee of the American Society for Reproductive Medicine. The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024). Fertil Steril. 2024;122(3). fertstert.org
Cornelisse S, Zagers M, Kostova E, Fleischer K, van Wely M, Mastenbroek S. Preimplantation genetic testing for aneuploidies in in vitro fertilisation. Cochrane Database Syst Rev. 2020;9:CD005291. doi:10.1002/14651858.CD005291.pub3
Human Fertilisation and Embryology Authority. Treatment add-ons ratings — pre-implantation genetic testing for aneuploidy (PGT-A) and immunological tests and treatments. Statement by the HFEA Chair, December 2025. hfea.gov.uk
Human Fertilisation and Embryology Authority. Endometrial receptivity testing. hfea.gov.uk
Human Fertilisation and Embryology Authority. Platelet-rich plasma (PRP). hfea.gov.uk
NHS. Ectopic pregnancy — Symptoms. nhs.uk
Royal College of Obstetricians and Gynaecologists. Ovarian hyperstimulation syndrome (OHSS) — patient information. rcog.org.uk
Society of Obstetricians and Gynaecologists of Canada. Guideline No. 460: Diagnosis and Management of Intrauterine Early Pregnancy Loss. J Obstet Gynaecol Can. 2025. doi:10.1016/j.jogc.2025.102914
ACCEPT Group. Australasian Recurrent Pregnancy Loss Clinical Management Guideline 2024, Part I. ncbi.nlm.nih.gov

All sources accessed: 29 July 2026

Medically Reviewed By

Nikolay Kornilov, MD

Medical Director · Reproductive Medicine

Member of the American Society for Reproductive Medicine (ASRM) since 2004 and of the European Society of Human Reproduction and Embryology (ESHRE) since 1998, with continuous participation in ASRM and ESHRE congresses.

Has contributed to meta-analyses and to publications in the Reproductive Medicine Guidelines, with more than 100 publications, lectures and presentations at Russian and international conferences. Has advocated the practical implementation of evidence-based medicine in reproductive care in Russia since 1998.