.jpeg)
.webp)
.jpg)
Miscarriage — whether it occurs in the early days or near the 20-week mark — is a shattering moment for anyone trying to conceive.
“A loss is a loss is a loss,” says Rescripted’s Co-Founder and Chief Creative Officer, Kristyn Hodgdon. Hodgdon learned she was pregnant about four weeks after undergoing in-vitro fertilization (IVF). But one week later, her happy news was classified as a chemical pregnancy, also known as a very early miscarriage.
Even though chemical pregnancies occur within the first five weeks of pregnancy, and may not seem like a big deal to the casual observer, the loss is still upsetting for expectant parents. “Chemical pregnancies get brushed off like they don’t count,” observes Hodgdon. “Whether you’ve been trying for years or just got pregnant, you were...and then you weren’t. That matters.”
Read on to learn more about why this type of miscarriage is called a chemical pregnancy, and why it’s so important to talk about pregnancy loss, even at these early stages.
Chemical pregnancy vs. clinical miscarriage: What’s the difference?
“A chemical pregnancy is a very early loss where there is an initial positive blood or urine pregnancy test,” explains Jessica Ryniec, M.D., a reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston. The term “chemical pregnancy” gets its name from the human chorionic gonadotropin (hCG) hormone that provides a positive pregnancy test result.
If the embryo stops developing, however, the hCG (aka the “pregnancy hormone”) levels not only won’t rise, they’ll eventually drop, as they did in Hodgdon’s case.
Soon after that positive pregnancy test result, if you’re experiencing a chemical pregnancy, “the pregnancy hormone levels decrease and bleeding begins, often seeming like a late period, says Dr. Ryniec. But, in fact, this is “a very early pregnancy loss.” A chemical pregnancy is also defined as one that “wouldn’t show up on an ultrasound,” Dr. Ryniec continues. This is because “typically, the pregnancy hormone starts decreasing before we would be able to see anything on a scan.”
A clinical miscarriage, on the other hand, occurs “when a pregnancy has been seen and confirmed on an ultrasound,” says Dr. Ryniec. She also explains that a clinical miscarriage typically occurs after the first five weeks (“most commonly before 12 weeks in the first trimester”). “Realistically,” she says, “the very earliest we anticipate seeing something on an ultrasound” is around the five-week mark, which “can define the line between a chemical pregnancy and a clinical loss.”
Any pregnancy loss after 20 weeks is considered a stillbirth.
Living through a chemical pregnancy
“I found out I was pregnant at four weeks after IVF,” Kristyn says of her chemical pregnancy. But instead of her hCG levels doubling within 48 hours, they “remained the same, and at the next blood draw [they] went down... so I was back down to baseline at around five weeks.”
Since chemical pregnancies occur so early, people don’t always realize they’ve miscarried. Because hCG blood levels are tested almost immediately during IVF, more chemical pregnancies have the potential to be detected.
“With fertility treatment, particularly IVF, we are testing hCG blood levels as soon as we reliably expect to see them being made by a pregnancy,” explains Dr. Ryniec. “This means that we can pick up on these chemical pregnancies more frequently.”
But for people who aren’t undergoing fertility treatments like IVF, they “may just experience a period that is a few days late and never test,” says Dr. Ryniec. “A pregnancy existed because the hCG levels were elevated; however, they did not increase normally and then declined.”
Still, even though all you had were elevated hCG levels, the loss is palpable.
"When you go through IVF, you find out you’re pregnant really early,” reflects Hodgdon. “And the thing is, you feel pregnant. The meds, the bloating, the hope. You're cautious, but you can’t help picturing the future. So when your beta drops, or never rises right, it doesn’t feel like 'nothing.' It feels like everything – and then suddenly, it’s gone."
Navigating your loss
From a medical standpoint, there’s usually no treatment following a chemical pregnancy. Dr. Ryniec does warn, however, that some cases “warrant close monitoring.” This is only because “occasionally, [hCG] levels can go quite high, and the concern may be raised for an ectopic pregnancy if an ultrasound is performed without seeing something in the uterus.”
In addition, if you’ve experienced multiple chemical pregnancy losses, “this does typically warrant an evaluation, and in some scenarios, treatment may be considered,” says Dr. Ryniec.
While you may not need medical treatment after a chemical pregnancy, that’s not to say you can just bounce back as if nothing happened. It doesn’t matter that the loss was “early” – the pain still exists.
Dr. Ryniec acknowledges that there’s still room for improvement with medical professionals when it comes to chemical pregnancies: “A lot of times I see patients who have been told in the past that these are ‘just' chemical pregnancies,” she says. “They are real pregnancy losses, and grief over these losses is valid. A history of chemical pregnancy losses should be paid attention to by health care providers.” “I’ve had both a chemical pregnancy and a clinical miscarriage,” reflects Hodgdon. “While the physical experiences were different, the emotional grief was the same. A loss is a loss – no matter how early it happens.”
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist dedicated to reporting on women's health, parenting, mental health, TV, and pop culture. Her work has appeared in HuffPost, Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.