Implications of chemical pregnancies

Like so many times in medicine, the one thing one should never do, is to generalize things. In this case this means that the meaning of a chemical pregnancy is not always the same and, therefore, must be appropriately interpreted: For a young and healthy woman in her 20s who just started trying to conceive, there, likely, is no clinically actionable meaning attached to experiencing a chemical pregnancy.

However, for a 39-year-old who was never pregnant  before and just experienced a chemical pregnancy in her first IVF cycle, there is a very distinct meaning attached to this diagnosis:

  • First, it demonstrates that she can create embryos that can implant;
  • Second, this fact alone, as studies have demonstrated, improves her prognosis for conceiving and delivering a healthy baby through IVF in comparison to women who did not experience a chemical pregnancy in her first IVF.

A chemical pregnancy may have a completely different meaning in a woman who had a previous clinical miscarriage and, now, in her next pregnancy, experiences the chemical pregnancy. As noted earlier, for us here at CHR, this sequence of events represents a warning sign that this patient may be entering a repeat abortion pattern. We attach the same meaning to repeat chemical pregnancies since we consider them with the same seriousness of purpose as repeat clinical miscarriages. Any suspicion that a couple may exhibit a repeat pregnancy loss pattern, whether primary (without a prior pregnancy and delivery) or secondary (with usually one prior pregnancy and delivery), deserves an appropriate investigation to either discover a chromosomal cause in one of the parents (a so-called balanced translocation) or  an immunologic cause in the mother.

What is important here is to interpret the chemical pregnancies on an individual basis.

This is a part of the December 2019 CHR VOICE.

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.