Chemical pregnancy/early miscarriage

[SerlingDavidson]

Hi,

My wife recently had a miscarriage. It seemed to be at about 5.5 weeks when the discharge happened but the nurse said it was a “chemical pregnancy”. We were booked in at just over six weeks for an early scan since she had what the doctor called spotting. The NHS is understandably overstretched so although the nurse was very compassionate (given she must see this kind of thing day in, day out) we were in and out in a blur.

I'm naturally a private person and have been more upset and anxious than I'm letting on. I just want to be a decent, supportive husband and be there for my wife.

However, I am also a natural born worrier and have a few questions and find it easier to ask via the anonymity of the Internet.

My questions are:

1.While I'm not even sure we had a chemical pregnancy as the discharge was nearly six weeks on, when you read the quite alarming miscarriage statistics, are CPs included? I've read miscarriages are between 1 in 3 to 1 in 5. Does this include CPs? We are both 30, by the way with no known medical issues.

1. It seems we know about CPs because pregnancy tests these days are so sensitive. This may sound like a really stupid question but is there any way to only test once an egg has attached?

1. We weren't trying for very long to get a positive test. Is it a good sign that we got a fertilized egg so soon? The thought that makes me sick to the stomach is what if we miscarry every single time. Is that something that happens to some people?

I know the later you miscarry the worse it is and for that I am grateful. Please don't think I am just making a mountain out of a molehill. I do appreciate people go through far worse than this. I guess I'm just trying to be a bit better informed for the future.

Many thanks,

First of all, I'm so sorry for your loss. I know it must be an extremely difficult time for you both and can understand your desire to find some answers. Unfortunately, as you are aware, miscarriage is extremely common and medical professionals are so used to seeing it that they forget how devastating it can be for the people involved.
I've had 2 chemical pregnancies/early miscarriages and two later miscarriages so have spent lots of time researching pregnancy loss and will try to answer your questions.

1. Statistics. There's a great deal of variation in the percentage of pregnancies which end in miscarriage precisely because of chemical pregnancies/very early miscarriage- many women just assume their period is late and don't bother testing, some women test positive then bleed soon afterwards without reporting the pregnancy to their GP, some women test positive then discover that the pregnancy has not progressed when retested by their GP- and, as far as I'm aware, there is no reporting procedure for early pregnacy losses of this kind.
2. It's not a stupid question! But pregnancy tests measure the hormone Beta HCG which is only released when the embryo implants in the uterus (usually 5 to 12 days after fertilzation of the egg has occured). So a positive urine or blood test indicates that implantation has occured. Urine pregnancy tests will tell you that this hormone is present but it is only by doing repeat blood tests to see that the HCG levels are doubling every 48 hours that you can have a reasonable indication that the pregnancy is progressing well. The problem with HCG is that the levels tend to take a few days to drop so you may still have a positive pregnancy test even though the embryo has stopped developing.
3. Unfortunately there are cases of multiple miscarriage (I'm one of them) but this is relatively rare and if it does happen, further investigation is usually done after three losses and there are treatment options available if a cause is found. It is a great sign that you managed to get pregnant very quickly- and you should have no difficulty conceiving again in the very near future.

All the best for the future.

I'm so sorry for and your wife's loss.

Sadly very early losses (before a pregnancy or heartbeat could be visualised on an ultrasound scan) are very common and the NHS are pretty matter-of-fact about it. It is still a pregnancy loss, though, and you and your wife are absolutely entitled to, and will need to , grieve so take time for that, and don't let anyone make you feel you're making a mountain out of a molehill because other people have had more or later losses.

The Miscarriage Association (www.miscarriageassociation.org.uk) has some good information and leaflets on its website.

The sad fact is that even if you are fertile and healthy, many fertilised eggs (60%+) just aren't chromosomally normal or healthy enough to implant properly and most of these are lost before or soon after the normal monthly period would be due. Very often people never even know they've lost a fertilised embryo unless they've taken an early pregnancy test. But by 6 weeks, the chances of the pregnancy continuing increase to 80% (4 in 5) and they quickly get steadily better from there. To stay sane you have to focus on the 80%, not the flip side which is the 20% chance of miscarrying.

You asked about whether there is a test which can tell you if the embryo has attached. Sadly the only truly reliable test is time. Implantation is an ongoing process throughout the first trimester. A home pregnancy test will tell you whether hcg (the pregnancy hormone) is above a certain level (some are more sensitive than others, so detect hcg earlier) but can't tell you whether the pregnancy is likely to be viable. A blood test any time from the day the missed period is due gives the precise hcg level which allows a more accurate "risk assessment" of whether the pregnancy is likely to continue or not, but from bitter experience, I would say that knowing you have a low positive and the embryo is unlikely to stay with you, doesn't really make it any easier. All you can do if you'd rather not know about chemical pregnancies, is to hold off from testing until a week or two after the missed period by which time the odds are more in your favour.

If anecdotal evidence helps, I had a chemical pregnancy (my first ever positive pregnancy test) earlier this year after my first IVF cycle. We lost the embryo at 5 weeks. However, the consultant was actually really positive about the fact that I'd (however briefly) been pregnant at all and saw it as a good sign. We went on to have a frozen embryo from the first cycle embryo put back in May, and that embryo is doing great so far - I'm nearly 7 months pregnant now and he's due in January, fingers crossed.

So hopefully you and your wife can take heart that this one loss, though very sad, doesn't mean that you have any underlying problem which will prevent a future embryo from implanting and thriving, once you've taken time to mourn the loss of this one and are ready to try again.

Sorry, cross-posted with lizziekal's really good advice.

Serling, if it's any consolation, i dont know anybody (personally) who has had a miscarriage and NOT gone on to have a successful pregnancy after.. a good % of my friends (off the top of my head i'd say 50%) have had 1 or 2 miscarriages but ALL have gone on to have healthy babies after... i would be far more worried if it had taken a long time to get pregnant. You'll be fine. Sometimes it's just mother natures way of handling chromosonal problems.
I'm 9 weeks today but still petrified about having a miscarriage. So i suppose the fear never leaves! But getting pregnant in the first instance is the most important part and you've already conquered that. Best of luck.

Wow, thanks so much for the fast and detailed replies.

@lizziekal So do you always have to have some degree of implantation to test positive? If so, how do you delineate between a chemical pregnancy and a non-chemical one?

Out of interest, if you do miscarry multiple times, what are the treatments? Like I say, I'm just trying to inform myself.

@ceara Fantastic advice, thank you!

@ChicaMomma Yes, that is very comforting to know and congratulations on 9 weeks! I can imagine the worry is always there and I always have to remind myself that it is magnified through the lens of maternal instinct.

Thanks again.

Hi Serling

Sorry for your situation. I hate the term chemical pregnancy. I thought I was having one last year and I felt so angry when my consultant told me that was what it was. It was actually an ectopic pregnancy in the end but I remember feeling like they were saying 'oh it's just a chemical pregnancy' as it it was never real.

In answer to your question, yes, you have to have had implantation to get a positive pregnancy test and your body does not produce the chemical that the tests are measuring until that has happened. It's just that sometimes the pregnancy just doesn't develop any further, usually because there is something wrong with the baby in some cases there are other causes like low progesterone. I think the difference between a chemical pregnancy and early miscarriage is whether the fertilised egg has developed from a blastocsyt where there are just a collection of cells multiplying trying to make the baby or whether an actual baby has formed.

In terms of treatment, they don't tend to do any tests until the 3rd consecutive miscarriage and at that point they look at what is expelled to see if there are any obvious reasons. They also do tests on the woman and the man to see if they can find something. My sister in law has had problems but they haven't been able to determine what is causing it at the moment. Treatment depends on the cause. Sometimes progesterone supplements can help if this is the issue, sometimes IVF is the answer.

What's important to note is that recurrent miscarriages are rare so just because it has happened once does not mean you will have it happen again and again although obviously you may be one of the unlucky ones.

I think this has been answered already but I think the figures of 1 in 3 pregnancies ending in miscarriage do include chemical pregnancies where people weren't aware because 1 in 3 is an estimate rather than reality.

I hope you get a lovely baby soon but give yourself time to get over what has happened to you both. It's very tough.

Yes. Some implantation has to occur to get a positive test. Basically, a chemical pregnancy is diagnosed when HCG is present (in blood or urine) and so 'biochemically' speaking there is a pregnancy but there is no visible evidence of the pregnancy on an ultrasound. HCG levels generally have to be above 1000 for the gestational sac (the first visible sign) to be seen on a scan and this occurs at around 5 weeks. If there is a sac seen on a scan but then the pregnancy doesn't progress (no yolk sac or fetal pole appears at around 6 weeks) then it is still an early miscarriage but rather than being called a chemical pregnancy it is labelled a blighted ovum. Obviously very few women are scanned before 6 weeks (usually only following fertility treatment, or in cases of suspected ectopic pregnancy) and so most losses before 6 weeks are called chemical pregnancies.
There are various causes of miscarriage (and many times the medical profession can't find any good reason)- in many cases there was some chromosomal problem with that particular embryo which will not reoccur (though there are certain genetic disorders which can cause recurrent early miscarriage but these are rare), and then there are other treatable conditions such as clotting disorders (some women are given heparin and/or baby aspirin as soon as they test positive), reduced hormone production (treated with progesterone supplements), immune issues (conditions such as lupus) which mean the woman's body attacks the embryo, untreated thyroid problems, infections and certain lifestyle choices (heavy drinking, smoking and drug abuse generally increase risk).
But remember that miscarriage is unfortunately extremely common and in most cases there are no underlying problems- that's why you will only get referred for testing if you've had three losses.

Thank you so much for your replies, they have been very, very helpful and reassuring.

All the best to everyone!

Sorry, just one further question. You know the NHS will look into underlying issues if you miscarry three times in a row? Just wonder, do they count chemical pregnancies in that?

I'm not sure, but do you have to tell them it was a chemical? what kind of evidence (if any) do they require?

A pregnancy is described as "chemical" if it can only be identifed chemically, in other words with a beta hcg test, as opposed to a "clinical" pregnancy which is far enough on to be visualised via ultrasound - that's the difference. It's still a pregnancy and as I understand it would "count" towards the three successive miscarriages to trigger recurrent miscarriage investigations. Certainly it does locally here.

However, please try to think positively for now that you and your wife are a long way away from having to go down that road. Just take it one day at a time for now, if you can (though I know it's hard).

Just to warn you, though, when your wife (fingers crossed) is pregnant with the embryo that's going to stay with you, and she attends the initial booking appointment with her midwife, she will be asked about any previous pregnancies but may well find the midwife doesn't "count" a chemical pregnancy as relevant for her purposes ie for antenatal care. So the notes will probably say "zero previous pregnancies". I hadn't expected that when I attended my own booking appointment, and as it was only a few months since we'd lost the first embryo, found it quite upsetting that the loss wasn't being acknowledged. So I thought you might want to be forewarned.

Best wishes.

Hi Serling, don't know if you're still reading but wanted to offer my condolences to you and your wife.

It is such a difficult time and the term chemical pregnancy makes me so upset, as if to wipe away the fact that your wife was pregnant, if only for a short time.

I suffered an early miscarriage last year, I was about 5+6, and it was devastating. I was so shocked. Thankfully, I saw a wonderful GP who explained that essentially, the human body is amazing at detecting problems with the developing embryo and getting rid of it. He told me that there was nothing I did or didn't do tomake it happen, and was hugely encouraging in terms of trying again.

Amazingly, I became pregnant the very next cycle and my 16 week old son is sleeping on me as I type.

There is some evidence that many women have a boosted fertility in the 2-3 cycles after a pregnancy.

And there is also evidence that 1 miscarriage makes you slightly less likely to miscarry the next pregnancy, although obviously some couples are unlucky enough to have repeated losses.

There is definitely hope for the future and I wish you both all the very best. In the meantime, do try and talk to your wife about how you feel. I am sure she would take great comfort from knowing that you love her and are so looking forward to making your family dream come true.

Sorry for the late reply. I am reading it but it has been a manic couple of weeks so I haven't had the chance to reply.

@ChicaMomma True, good point.

@ceara Thanks, you're right, I am just a massive worrier and always dwell on worst case scenarios. I thought they may not “count” it. Chemical pregnancy is such a horrible term, so sterile.

@BraveLilBear Thanks, your post was really comforting and congratulations on your son!

Regarding your point that “there is also evidence that 1 miscarriage makes you slightly less likely to miscarry the next pregnancy”…one thing I've read online is around half miscarry on their first time inferring that the first occasion implantation occurs in a woman's body, miscarriage is higher. Is there any truth to this or is it an urban myth?

Thank you, this site is great.

I hate the term "chemical pregnancy" and I don't think the nurse was using it correctly anyway. It means that you get a positive test on one of the early-response pregnancy tests but then your period arrives when expected i.e. a 4 week miscarriage. Anything later than that is an "early miscarriage"
You've had lots of good advice from the others. I think the generally accepted figure for established pregnancies (after a period is missed) is 15% so your wife's experience is very common. Your chances next time are still 85% positive, the same as someone who has never been pregnant.
Recurrent miscarriage (3 or more in a row) only affects 1% of couples, so you have every chance of a successful pregnancy next time.

I've had 4 miscarriages and, after tests and treatment, am now 13 weeks pregnant, so there is hope even for the 1%, but I'm sure you will not find yourselves in that situation.

I had investigations and treatment for recurrent miscarriage and they did count an early 5 week loss towards the three miscarriages. I didn't call it a cp, i called it a very early pregnancy loss. I went on to have a healthy baby soon after and am now pregnant again.
there is every chance that you and your wife will have better luck next time. Try to stop looking up the statistics online for now as i think dr google is causing more anxiety. Focus on trying again. If either of you is a smoker then giving up now will give you one less reason to worry next time. That said, most miscarriages are due to chromosomal abnormalities and are not preventable. The risk goes up with age but under 35 you are not at increased risk.

Thanks so much for the kind words and the reassurance.

One final question (I keep saying that!):

I had to go to the doc about something else and mentioned what had happened and asked, “so does that at least mean we can get pregnant?”

I don't know if she understood me correctly but she said, no, generally you need to make it to eight weeks before you can say that and I inferred from what she said our positive test meant nothing. Is that true? I always assumed people who “couldn't get pregnant” never even got any sort of implantation. Am I being ignorant here?

Finally, can someone explain to me how you know the date of conception. We tested positive a few days after a missed period and then negative two and half weeks later. Can someone please help me understand the maths here? To avoid detecting things too early should you wait at least a couple of weeks after a missed period?

Thanks again, really, I do appreciate this.

I can't answer the first part, but the midwives don't really go by date of conception, it goes from the date of the last period. For example I conceived early august, but my pregnancy is dated from the first day of my last period which was in July. I tested 4 days before my period was due and was negative, tested again on the day and got a pretty much instant positive.
No idea if that's answered you or if I've understood wrong!

Welcome back. Regarding what your doctor said I think she was being a bit negative.It's good news that your sperm are capable of doing what they're supposed to and that you managed to get through to the initial stages of pregnancy (ie fertilised egg began cell division and implanted in the uterine lining for long enough to produce BetaHCG) though, admittedly, what you experienced wasn't classed as a clinical pregnancy because it was too early to see anything (embryo with heartbeat) on a scan. It sounds to me like she was hinting at the small possibility of there sometimes being certain factors (both on the male and female side) which make a successful pregnancy unlikely or impossible. After one miscarriage, though, most medical professionals would tend to agree that your chances of having a healthy future pregnancy far outweigh the likelihood of you having such problems.
With regard to conception, the problem with getting an exact date is that while it is possible to know roughly when ovulation occurs (in most women with a 28 day cycle it is around 14 days in), sperm can exist in the body for up to 3 days before fertilizing the egg and it takes between 5 and 12 days for this to then implant. Depending on when implantation happens, in some cases you'll get a positive pregnancy test 4 days before missing a period, while in others it can take up to a week for enough HCG to be present in the urine for a positive test. The problem, as you have discovered, is that a positive urine or blood test is no guarantee of a successful pregnancy and it is only when a heartbeat is detected on an ultrasound that the chance of miscarriage drops significantly.

Me and my wife had been trying to get pregnant for about a year. we have gotten on three separate occasions positives test and with in a week she has lost each time. Last year she was told she had pcos and she is really taking this last one really hard as her husband it hurts my heart to see her in the pain she is in. I'm looking for some way to bring comfort because nothing I can say has helped.