Compared with a natural pregnancy, the occurrence of fetal demise after IVF pregnancy is often more heartbreaking. The following chart is a comparison of the IVF pregnancy rate and live birth rate of each age group in Taiwan in 2018. It seems that the live birth rate of each age group will be about 5-10% lower than the pregnancy rate. These fetuses who are already implanted but cannot keep living may be fetal demise.

Possible reasons for fetal demise.

The causes of fetal demise are very complex, and the following reasons are possible: obesity, chromosomal or genetic abnormalities, endocrine abnormalities (thyroid disease or diabetes), bad lifestyle habits (smoking, drinking, drug abuse), infections, uterine abnormalities (Bicornuate uterus, uterine septum, uterine fibroids, etc.), immune or blood coagulation abnormalities, environmental pollutants (environmental hormones, air pollution, etc.), malnutrition, stress, umbilical cord accidents, chemical agents or radiation exposure, etc. But generally we can distinguish the common causes of fetal demise according to the pregnancy period.

First Trimester (Getting pregnant to 13 weeks +6 days)

More than 50% of fetal demises are caused by chromosomal abnormalities. Due to chromosomal abnormalities, the embryo cannot continue to develop. Ultrasound will find a blighted ovum or the fetus with no heartbeat (blighted ovum). Therefore, some couples will choose to do pre-implantation genetic screening (PGT-A). Studies have shown that it can reduce the abortion rate from 19% to 14% for women aged 35 to 40, from 40% to 22% for women over 40 years old. But it cannot be reduced to 0%, because there are other reasons that may cause fetal demise.

Second Trimester (14 weeks to 27 weeks + 6 days)

In this pregnancy period, fetal demise is more related to uterine malformations or cervical incompetence. Some genetic abnormalities can cause fetal edema or demise (severe thalassemia). Others such as infections, immune abnormalities, and umbilical cord torsion may also cause fetal demise.

Third Trimester (28 weeks until delivery)

At this period, it is mainly related to complications of pregnancy, such as early placental separation, umbilical cord prolapse, fetal oversize, preeclampsia, and poor control of gestational diabetes, etc. The most important thing before delivery is to pay attention to fetal movement. If there is less fetal movement, and there is no improvement after eating or shaking, it is best to go to the hospital for examination as soon as possible.

Can we prevent fetal demise from happening?

There is currently no effective way to prevent fetal demise, but some changes can be made to reduce the risk of fetal demise. For example, avoid smoking, alcohol, caffeine, and any potentially harmful drugs, stay away from polluted environments, and a healthy diet with adequate nutrition, cooperate with doctors to control endocrine abnormalities or immune coagulation, keep the mood relaxed, and happy. As long as you continue to maintain your confidence and hope, you will surely have a happy result of happiness and joy in the end.