Miscarriage During a Surrogate Pregnancy

Did you know that approximately 10% of pregnancies end in miscarriage? Even if you have never experienced a miscarriage yourself, it’s pretty likely that you know someone who has. Since they are so common, miscarriages do sometimes even occur during surrogacy pregnancies, regardless of a surrogate’s stellar medical history. Since you definitely can’t predict exactly what will happen in your surrogate pregnancy, it’s best to be prepared for various possibilities; this can make it easier to cope and move forward with the next steps, in the event that the pregnancy doesn’t go as planned.

Possible Causes of Miscarriage

Miscarriage is defined as "the loss of an intrauterine pregnancy within the first trimester”. Some of the many potential causes of miscarriage include:

• Chromosomal abnormalities (responsible for approximately 50% of miscarriages)
• Maternal health problems
• Drug or alcohol use

The following risk factors for miscarriage have also been identified:

• Maternal age
• Previous miscarriages
• Uterine or cervical structural abnormalities
• Weight
• Invasive prenatal testing

In most cases, miscarriage cannot be prevented. Your normal everyday activities, such as working and caring for your children, do not cause miscarriage. Instead, it is often nature’s way of telling us that a particular pregnancy was not viable due to genetic errors or abnormal fetal development.

Since miscarriage is relatively common during the first three months of pregnancy, surrogates and intended parents often start to feel more confident about the pregnancy after the first trimester passes.

What Happens During and After a Miscarriage?

Miscarriage during your surrogate pregnancy may become apparent after you experience symptoms like bleeding and cramping. (Keep in mind that these symptoms do not always indicate an impending miscarriage, though.) Or, you may attend a routine medical appointment, where you learn that the gestational sac is empty, or the baby has stopped growing and doesn’t have a heartbeat.

If any of these scenarios do occur, it is very important that you immediately seek and accept care from your medical provider, who will also advise you on your next steps. Effective treatment options for miscarriage may include:

Expectant management
This option lets the miscarriage progress on its own, allowing the tissue from the pregnancy to leave your body naturally. The length of time this process takes can vary significantly, possibly lasting anywhere from two to four weeks. As you might imagine, needing to wait for the inevitable to happen, or needing to endure unpleasant symptoms over this period of time, can be emotionally challenging.

Medical treatment
If you prefer to complete the miscarriage naturally but more quickly, your medical provider may prescribe medication to speed the process along. This medication, taken either orally or vaginally, causes your body to expel the pregnancy tissue, often within 24 hours. Some surrogates do report increased cramping with this method.

Surgical treatment
A final option is to schedule a D&C (dilation and curettage), which is a minor surgical procedure often performed under general anesthesia in a hospital setting. This procedure involves dilation of the cervix and removal of the tissue inside the uterus. Luckily, complications from this procedure are uncommon; although there is typically mild cramping and light bleeding afterward, most women do resume their normal activities as soon as a day or two after the surgery. This treatment option does also offer the greatest possibility of being able to test the fetal tissue afterward, in the event a genetic abnormality that contributed to the pregnancy loss can be identified.

As long as you don’t have an infection and you are not experiencing unusually heavy bleeding, your medical provider will likely ask you for your treatment preferences. Prior to making a decision, be sure that you know the risks versus benefits of each approach. For example, allowing the miscarriage to progress naturally does not necessarily mean that you will avoid a D&C. In many cases, miscarriages remain incomplete, which may also result in an eventual D&C.

Psychological Effects of Miscarriage

Aside from the physical consequences of a miscarriage, there are also significant emotional aspects to consider. Miscarriage is a loss that is always sad and painful for surrogates and intended parents.

What You May Feel

You may experience a wide range of emotions at different points in time, spanning from shock and anger to guilt, denial, and sadness. Since you are carrying someone else’s baby, you may also find that your emotions are surprising to you, in that they are “different” than what you expected or what you felt after having a miscarriage of your own in the past.

Many surrogates who experience miscarriage report feelings of intense sadness for their intended parents, since it is the loss of their baby and their dream. This sadness feels different than the sadness you may encounter when losing your own pregnancy, and in some ways it may also feel more complicated.

How to Cope with Your Emotions

You may find it helpful to lean on your family and friends, your fellow ConceiveAbilities surrogates, your match manager, and your support group leader. They are all there to provide comfort; remind you that you are not alone; and encourage you to accept your feelings as they arise. Should you start feeling overwhelmed by your emotions, talk to a professional counselor or your medical provider.

Navigating the Relationship with Your Intended Parents

Your intended parents will also face complicated emotions, of course. While coping with their own grief, they may also be very concerned about your well-being, and how the miscarriage may impact their future family-building plans. While checking in with them after learning about the loss is a good idea, you may want to follow their lead with respect to communication after that point. If you’re not hearing from them as frequently, try not to take this personally. Keep in mind that they too are trying to heal emotionally from an extremely painful loss. Your ConceiveAbilities match manager may be able to offer some additional insight into their healing and thought processes, so feel free to ask.

Determining Your Next Steps after Miscarriage

After your miscarriage has completed, your medical provider will review the steps for your follow-up care, as well as tell you what to expect from your body afterward. Meanwhile, your intended parents will likely consult with the doctor at their fertility clinic to ask questions and seek recommendations for their next steps, too.

Assuming that embryos remain and everyone is in agreement, many GCs and IPs will move forward with another embryo transfer together, after the surrogate’s body has healed and her menstrual cycle has returned. The length of time between a miscarriage and a subsequent embryo transfer will depend on your body, on the recommendations of your medical provider and the fertility doctor, and on all parties’ emotional readiness to proceed with another transfer.

Remember, if you and your intended parents suffer a miscarriage during your surrogacy journey, you are not alone, and it does not necessarily signal the end of the journey or the relationship. Many ConceiveAbilities surrogates who have had miscarriages have gone on to carry and deliver perfectly healthy, bouncing babies for their intended parents!

Written By Lori Jureko