The Little Death: Pre-Implantation Miscarriage

Many of us know someone who has suffered the devastating loss of a child during pregnancy. But what of couples who lose a child even before it had the opportunity to grow? The term "pre-implantation miscarriage" is generally only known by those who have undergone in vitro fertilization, or IVF.

In October 2016, my husband and I began our first round of IVF. Our cycle went very poorly - unusual given my young age and high egg reserve – only three eggs were retrieved. In what felt like a miracle, one of those eggs was successfully fertilized and became an embryo. It then made it to blastocyst stage, significantly increasing the likelihood that that it would become a baby. We had so much hope that this embryo would become our son or daughter.

Image of a 5-day blastocyst, similar to the photo we received

Seeing the photo of our five-day old embryo, I started to become attached – "baby's first photo". It already felt like a little person, despite only being a few hundred cells large. A week and a half after the embryo was placed in my uterus, I felt a deep loss when I found out that it was no longer growing.

Something terrible had happened to us, but we did not have a label for it, beyond a failed IVF treatment cycle. Yet, it felt like so much more than just a failed procedure. It was not until I read the book Unsung Lullabies that I learned that our loss did have a name:

"When in vitro fertilization has occurred, infertile couples often experience the embryos as potential babies and find themselves already feeling emotionally attached. When those cells don't implant, couples feel as if a baby has been taken from them. Until recently, there has not even been a name for such a 'death', which some researchers are now calling a 'pre-implantation miscarriage' or 'non-carriage'. Giving this loss a label makes it that much more real, allowing couples to feel validated in their grief."

As part of a study we were participating in during our first IVF cycle, the embryo was biopsied prior to being placed into my uterus to determine if it was "genetically normal." A genetically normal embryo has a pair of each chromosome, 46 in total. An embryo is considered genetically abnormal when it has an abnormal number of chromosomes. An example of this is Trisomy 18, when an embryo has three copies of chromosome 18 instead of two. Embryos that are genetically abnormal usually do not implant (create a pregnancy), and if they do, the end result is often miscarriage or stillbirth, since most conditions associated with the incorrect number of chromosomes are not compatible with life.

The genetic testing would also tell us if the embryo was a boy or a girl. After our pre-implantation miscarriage, we thought it would be best not to know the gender of the embryo. It felt like too much to handle, since to us it seemed to humanize the embryo even more.

I assumed we would find out the results at a doctor's appointment, and have the opportunity to decline to know the gender. Things happened a little differently than expected. Almost a month after our loss, a nurse at our clinic emailed me the genetic results of our embryo, and without warning, I found out the sex. Our embryo was a girl. She was missing a chromosome 4, which meant she would never have had a chance at life to begin with.

I was at work when I received the email. I remember being overcome with emotion, escaping outside the building, even though it was a cold December day. I called my husband, and through tears, told him what I had just found out. Even though I was outside, there were others around – there was no place to mourn privately.

If things had been different, I would have given birth to a daughter this summer – her due date would have been July 25th. It feels impossible to completely move on from this loss, even with the immense joy associated with the upcoming arrival of our son.

I am so happy to be pregnant now with our son. Sometimes I feel guilty that I do not feel more sadness over the loss we experienced. I do feel it though; it often comes in waves. During June and July, I attended many prenatal yoga classes where the majority of the women in attendance had July due dates. I could not help but think that could have been me, too.

I know that if our first IVF cycle had gone to plan, I would not be pregnant now with our son. However, I have learned that a baby never replaces another baby, even if that baby was only ever an embryo.