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bleeding during ivf pregnancy

Bleeding During IVF Pregnancy- What’s Normal and What Isn’t?

| 08 Nov 2023 | 71116 Views |

Pregnant women undergoing in vitro fertilization (IVF) may experience anxiety and worry when they experience bleeding. While infertility struggles can be overcome with IVF, there are a number of unknowns involved, including the potential for bleeding. 

This post will discuss the typical reasons and possible effects of bleeding during IVF pregnancy, thereby easing the concerns of individuals going through this unusual and difficult process.

Bleeding During IVF Pregnancy: Is It Common

In the first trimester of pregnancy, about 25% of women suffer spotting or bleeding, especially in IVF pregnancies or IVF embryo transfers. 

This is because the IVF specialist prescribes exogenous hormones, which are necessary for pregnancy sustainment during IVF but are not generated naturally. As such, it is imperative that patients take their prescription drugs on a regular basis.

Why Am I Spotting Or Bleeding?

When blood vessels burst during the embryo’s attachment to the uterine wall, usually before menstruation, it results in embryonic implantation hemorrhage. This bleeding, which might be pale pink or faded brown, could be a sign of a recurrent miscarriage. 

Rarely, it could be a sign of a difficult pregnancy. The chance of bleeding during the first trimester is higher in a pregnant multiplex. When an embryo is connected outside the womb, it can result in ectopic pregnancy with either severe or mild bleeding. 

bleeding after ivf pregnancy - ectopic pregnancy

Bleeding can also result from natural sexual contact, causing irritation. Hematomas or subchorionic hemorrhages happen when blood seeps between the embryo’s surrounding membrane and the uterine wall. Molar pregnancy is a rare condition in which a genetic mistake after fertilization causes aberrant growth of the placental tissues.

Early Pregnancy Monitoring

Six weeks into an IVF pregnancy, bleeding is normal but not unusual. Telling your healthcare professional is essential to preventing major problems. For the patient’s health, a positive pregnancy test is crucial. 

An obstetrician is consulted when the pregnancy has been observed for ten weeks. For the first seven weeks, the patient is given progesterone injections or pills. Age, ovarian health, and embryo care are next addressed. 

An initial ultrasound examines the attachment and heartbeat of the embryo, while a second one tracks the embryo’s growth and development. When the second ultrasound reveals viable fetal development and heart activity, the patient is released from the hospital.

How Do I Evaluate Early Pregnancy Bleeding?

  • Certain tests can be used to assess bleeding during the first trimester of pregnancy.
  • To confirm pregnancy during early pregnancy bleeding or spotting, a urine or blood test might be used.
  • An ultrasound examination of the uterus or vagina verifies the pregnancy.
  • The likelihood of miscarriage will decrease with age. Miscarriage rates are higher as one age, that is, beyond 40. The likelihood of miscarriage in this situation is more than 50%. A blood test will verify your blood group.
  • After that, D-immunoglobulin injections are required to prevent future pregnancy.

Bleeding During The 2-Week Wait With IVF

Women undergoing IVF cycles may have anxiety if they experience bleeding while on luteal phase support, which uses progesterone and estrogen to strengthen the uterine lining. 

This might cause them to get obsessed with every blood drop because they are afraid of their period starting or their cycle ending. But it’s crucial to remember that embryos at this stage are little and invisible to the unaided eye. 

Bleeding is not necessarily a sign that the cycle is failing; it might be self-limiting and end abruptly, making it challenging to identify the source or reason. On occasion, it might be a positive indication of implantation bleeding. 

A blood test to measure progesterone levels may be useful since ultrasound scanning cannot provide a clear picture of the condition.

Could I Have Done Anything Wrong To Have Caused Bleeding And Spotting After Ivf Embryo Transfer?

Spotting and bleeding after an embryo transfer is rare if you have taken the luteal support medication as directed. The Indore IVF center provides post-transfer guidance. 

To avoid spotting or bleeding, avoid doing things like using the stairs, sitting on the floor, crossing your legs, taking a bus, eating hot feet, and consuming small amounts of papaya or pineapple.

What Causes Bleeding In IVF Pregnancy?

1. Implantation bleeding

For individuals bearing multiples, one or more days following embryo transfer is when implantation hemorrhage often begins. The symptoms often appear around the time a patient may anticipate their menstruation and resemble PMS. Lighter flow, color, and duration are among the symptoms. 

Back pain, headaches, nausea, breast tenderness, and light cramping are some more possible symptoms. 

The most accurate way to diagnose implantation hemorrhage is to monitor hCG levels. In cases where symptoms correspond and early hCG levels double every 48 to 72 hours, implantation is most likely the cause of the bleeding. It’s possible that patients who are carrying multiples are more susceptible to implantation hemorrhage.

2. Subchorionic Hemorrhage

Blood can accumulate between the uterine wall and the gestational sac in a condition known as subchorionic hemorrhage, which has an incidence of 1.3 to 62%. 

It can happen when the placenta separates from the uterus, particularly in pregnancies that were induced by IVF and had a B or C grade. 

Light to heavy bleeding, pink, red, or brown blood, cramps, or lower abdomen discomfort are among the symptoms. 

The extent of the hemorrhage, the patient’s age, and the fetus’s gestational age are the key elements that determine the prognosis, and a transvaginal ultrasound is essential for diagnosis and prognostication. 

The rate of miscarriages is higher in patients detected before seven gestational weeks, whereas those under 35 had a reduced miscarriage rate.

3. Polyps

The hormonal changes that promote swelling and swelling in the reproductive system during pregnancy make cervical and endometrial polyps, which are generally benign, more prone to bruising and bleeding.

4. Vaginal/Cervical Irritation

Regular vaginal exams, the use of tampons, sexual activity, and other factors may irritate the cervix and vagina, leading to mild bleeding. An increase in bleeding has been associated with repeated transvaginal ultrasounds.

How Much Bleeding Is Normal After IVF?

Light spotting or bleeding, commonly pinkish or brownish, is usual after IVF embryo transfer. It is also rare to see a tiny bit of brilliant crimson blood that generally ends on its own.

When Should I Be Worried About Bleeding During Pregnancy?

Significant blood loss is indicated by heavy bleeding, which is defined as one standard-sized pad soaking through in an hour. Chest pain, weakness, nausea, vomiting, cold, and discomfort in the abdomen are some other symptoms. Shoulder discomfort can also result from an ectopic pregnancy rupture.

When To Contact Your IVF Doctor

The doctor suggests stress reduction, rest, eating a balanced diet, and refraining from sexual activity if the bleeding is not too severe. Pregnant women should consume folic acid, prescription medications, and vitamins. 

Bring the discharge to the clinic and get in touch with the doctor right away if the bleeding is significant. Miscarriage or partial miscarriage may occur in severe instances. 

To avoid additional infection, the doctor will carefully suction any residual tissues and undertake a procedure to see if all tissues have been discharged.

Conclusion

To sum up, bleeding during an IVF pregnancy is not unusual and might have a number of underlying reasons. It’s important for pregnant moms to speak with their healthcare professionals and get the support and direction they need, even though doing so might be upsetting. 

Since every pregnancy is different, doctors may provide individualized treatment to address any worries. Many women who have bleeding during IVF go on to have successful pregnancies with the right monitoring and care. Recall that your healthcare team is at your side the entire time, so never feel alone on this trip.

Bleeding During IVF Pregnancy FAQ’s

1) Is bleeding common in IVF twin pregnancy?

Bleeding can occur in IVF twin pregnancies, just as in singleton pregnancies. However, the likelihood of bleeding can vary from person to person and may not necessarily be more or less common in twin pregnancies specifically due to IVF.

2) How can I differentiate between normal and abnormal bleeding during IVF pregnancy?

Normal bleeding is usually lighter, occurs around expected period time, and doesn’t last long. Abnormal bleeding is often brighter, may be persistent, and is associated with severe symptoms like pain or heavy bleeding. If in doubt, consult your healthcare provider for evaluation.

3) Can bleeding be a sign of a miscarriage in an IVF pregnancy?

Yes, bleeding can be a sign of a miscarriage in an IVF pregnancy, but it doesn’t always mean a miscarriage is occurring. While some bleeding may be normal (implantation bleeding or minor spotting), heavy or persistent bleeding, especially when accompanied by severe pain, can be a cause for concern.

About The Author
Dr. Richika Sahay

MBBS (Gold Medalist), DNB (Obst & Gyne), MNAMS, MRCOG (London-UK), Fellow IVF, Fellow MAS, Infertility (IVF) Specialist & Gynae Laparoscopic surgeon,[Ex AIIMS & Sir Gangaram Hospital, New Delhi]. Read more

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