Is a “Chemical Pregnancy” a “Miscarriage”? Terms Explained

Is a “Chemical Pregnancy” a “Miscarriage”? Terms Explained
After a blighted ovum miscarriage about 6 months ago, I was cautiously optimistic that I would go on to have a healthy pregnancy. I was comforted by sources like Mayo Clinic, stating that only about 1% of women have repeated miscarriages. Fast forward a few months, and I have since had two chemical pregnancies.
 

Because sources like WebMD refer to chemical pregnancies as early miscarriages, I assumed that I was part of that unlucky 1% who have multiple miscarriages.

I have since learned though, that despite the fact that many online sources refer to chemical pregnancies as very early miscarriages, they are not always technically considered miscarriages or included in a “recurrent miscarriage” count.

Confusing, I know.

And frustrating as I tried to sort out my thoughts and feelings about my early pregnancy losses, and whether or not I should seek out testing and treatment for “recurrent miscarriage” fertility issues. So I did a deep dive into the question of whether or not a chemical pregnancy is considered a miscarriage. 

My First Chemical Pregnancy Experience

A few months after my blighted ovum miscarriage, my husband and I decided it was time to try and get pregnant again.

So when the time came, I was excited to take a home pregnancy test. And I got a positive result! So I took another to confirm, and it too was positive! While I was happy about this good news, I also felt fearful. My previous experience of miscarriage was truly unpleasant, and I certainly did not feel immune to the possibility of another.

And about a week and a half after those positive tests, I was crushed when I started having some vaginal bleeding. And that was that. The bleeding lasted for about 5 days, and was a bit heavier and more uncomfortable than my normal period. Had I not been tracking my menstrual cycle and taken those positive pregnancy tests, I might have just assumed I was having an extra heavy and late period.

Once this pseudo menstrual period was over, I took another pregnancy test to see if my hCG levels (pregnancy hormone) had fully dropped, and sure enough the test was negative. I don’t really know why I wanted to confirm that I was no longer pregnant when I already knew. I think I was just trying to process it all and see if my body had fully registered the loss that I was trying to grapple with in my mind. I felt disappointed and off kilter for a couple of weeks. 

My Second Chemical Pregnancy

Before I knew it, my cycle resumed and I again found myself anxiously waiting to take a pregnancy test. The first one I took was a faint positive test result. So I continued to take them every morning, waiting to see if the line that detects hCG (human chorionic gonadotropin hormone) would get darker. Even though I knew I should have been waiting at least a few days in between tests, I couldn’t help myself. 

But I just kept getting faint positives day after day. I started spending way too much time googling chemical pregnancy line progression images and all the reasons a person might get ongoing faint positives. And even though I really wanted to believe that everything was just fine, I think I knew another chemical pregnancy was underway.   

And then again, about a week later, the physical confirmation of what looked like a heavy late period arrived.

As a disclaimer, I should note that I did not have my chemical pregnancies confirmed by a doctor. A doctor can confirm a chemical pregnancy with a blood test, but an early at-home pregnancy test is also a way to know if your body has started producing hCG.

And I ultimately did not feel I needed to go to the doctor, as sites like WebMD explain that there is usually no treatment required for a chemical pregnancy. This is not to be confused with later miscarriages though, where treatment may be needed if all the pregnancy tissue is not expelled naturally or if there is hemorrhaging. In these cases women may need emergency medical attention or a surgical procedure called a D&C (dilation and curettage) to scrape the remaining tissues from the body.  

Please note that I am only speaking of my own personal situation, and anyone with questions and concerns regarding their health (mental health or physical) should go see a doctor.

What is a Chemical Pregnancy? 

Cleveland Clinic defines a chemical pregnancy as an early miscarriage that happens before the fifth week of pregnancy. An egg is fertilized and the body begins producing the pregnancy hormone hCG, but an embryo does not continue to develop after implantation.

Since the pregnancy stops progressing so early, many women who have not taken early pregnancy tests or who have not visited their doctor may not even realize they were ever pregnant.

The signs and symptoms of a chemical pregnancy on both occasions in my case were as follows;

  • Multiple early positive pregnancy test results (with faint lines that never progressed).
  • Mild early pregnancy symptoms that only lasted for a couple of days and then disappeared.
  • Heavy bleeding (as compared to my normal period) accompanied by low back pain and abdominal pain about a week and a half after my expected period dates.

Is a Chemical Pregnancy a Miscarriage? 

As I started sifting through information online and trying to figure out what my miscarriage and consecutive chemical pregnancies might mean for a potential future pregnancy, I found myself a bit confused. After doing some online digging, I realized that while a “chemical pregnancy” is often referred to as an “early miscarriage”, it is not technically a “miscarriage”, according to some. 

Perspective 1: A Chemical Pregnancy is a Miscarriage

As already discussed, Cleveland Clinic states that a chemical pregnancy is a very early miscarriage that happens within the first 5 weeks of pregnancy. An egg is fertilized, however the embryo does not continue to develop after implantation and this results in miscarriage. 

The term miscarriage is clearly associated with the term chemical pregnancy here.

Perspective 2: A Chemical Pregnancy is Not Technically a Miscarriage

Baby Center on the other hand, states that a chemical pregnancy is not really a miscarriage medically speaking, because a woman has never been clinically pregnant. Baby Center defines clinical pregnancy as being able to see a gestational sac on an ultrasound or hear a fetal heartbeat.

So while conception has occurred with a chemical pregnancy and the body starts producing the pregnancy hormone hCG, the pregnancy never progresses to the point that further evidence of a growing embryo is detected. 

In these cases, a very early pregnancy loss is considered a biochemical pregnancy, aka a chemical pregnancy, and not a miscarriage. 

My Doctor’s Perspective

To further confirm that different sources have varying opinions on what counts as a miscarriage or not, I recently visited my doctor. She considered my chemical pregnancies as miscarriages. In her eyes, pregnant is pregnant. 

In various online forums though, I read comments from women who said their doctors essentially dismissed their chemical pregnancies and did not regard them as miscarriages. So even among the professionals there seems to be a lack of consensus. I am inclined to adopt the perspective of my doctor, as I trust her and think she is an excellent doctor. 

My Perspective After My Chemical Pregnancy 

So as I reflect on these different perspectives regarding the term chemical pregnancy vs miscarriage vs recurrent miscarriage, I’m left feeling uncertain.

In my case, conception did in fact occur and I had a positive pregnancy test result, but I was apparently never technically pregnant. I was biochemically pregnant, not clinically pregnant. So am I not supposed to feel as bas about these biochemical losses? Biochemical seems like such an odd word to pair with the word loss. Or do the technicalities of all these terms not even matter. For some reason, they really mattered to me. I desperately needed a way to make sense of my experiences. 

So when I did not know what words to use to categorize my experience, I felt like I could not fully process what had happened. Dealing with early pregnancy loss and all the hormonal shifts and disappointment is such a horrible drag, can’t we at least all agree on some commonly agreed upon language to talk about it? So that women can process their experiences and take care of their mental health? And so that there are clear guidelines regarding when or when not to seek testing for chemical pregnancies and miscarriages? 

Do Recurrent Chemical Pregnancies Count as “Recurrent Miscarriage”?

As I was trying to figure out my next steps and what to do about my recurring pregnancy losses, if there was in fact anything to be done, I came across websites like Tommy’s stating that a woman should seek testing or treatment after “recurrent miscarriage” (3 or more consecutive miscarriages).

Was I a candidate for testing or treatment for recurrent miscarriage with 2 chemical pregnancies and 1 blighted ovum miscarriage? As an otherwise healthy person, would a doctor think my chemical pregnancies were even significant? Would they scoff at me if I asked for testing to find the cause of my early pregnancy losses?

Many resources I found online about the topic are not clear on whether or not “chemical pregnancies” factor into “recurrent miscarriage”. It was so frustrating trying to comb through all of the varying opinions presented as facts online.

I found at least one site though, that was more upfront about the confusion on the topic. USC Fertility explains that it is unclear whether chemical pregnancies should be counted in a “recurrent miscarriage” count.

After talking to some friends who also had chemical pregnancies though, I decided to check in with my doctor after all to see if there was anything I could do to help maintain a pregnancy. 

And as it turns out, my doctor did consider my chemical pregnancies miscarriages. Since I had a medical history of a blighted ovum miscarriage and now the two chemical pregnancies, she said I could start some testing to try and figure out what was going on. I also asked her about taking progesterone, as I had a friend explain she started taking it after repeated chemical pregnancies. My doctor agreed to prescribe me some. 

So just one scenario of which I’m sure there are many that play out differently depending on the doctor. 

How Common are Chemical Pregnancies?

As it turns out, chemical pregnancies are very common. I found it difficult to find statistics (at least ones that site their sources) on chemical pregnancies, but I will share what I could gather from reputable sources online;

Obstetrics & Gynecology Science (a peer reviewed journal) states, “the incidence of biochemical pregnancy is between 8% and 33% of all pregnancies”. That seems like quite a large range, which indicates to me that there are a lot of unknowns when it comes to rates of chemical pregnancies.

Another stat from UCLA Health states that “it is estimated that at least 30-60% of all conceptions will end within the first 12 weeks of gestation. Up to 50% of the time, the woman doesn’t even realize that she was ever pregnant”. Again, that seems like a big range. Pillarisetty & Mahdy (2022) also state that “up to 50 percent of patients with RPL (repeated pregnancy loss) have no clearly defined etiology”.

Another stat from Copperstate OB/GYN  states that “chemical pregnancies account for 70% of all conceptions.” That’s a pretty large and interesting percentage; however, they do not site their source. So I’m not sure how reliable this statistic is. 

The overall consensus though, seems to be that chemical pregnancies are quite common. And for many women, they will never know the exact cause of a chemical pregnancy. 

What I ultimately spent some time doing and that I found more useful than trying to rely on sourceless statistics on the web, was reading through online forums of women sharing their experiences with very early pregnancy loss. When I did this, I realized that there really are a lot of women who go through chemical pregnancies, and that my experience was not entirely unique.

Living with Uncertainty, Hoping for the Best

So I am learning to live with uncertainty, while hoping that my next pregnancy will go according to plan. I also know though, that I may not ever get pregnant again or stay pregnant, and I may never know the underlying cause.

While I may not have many answers, I do hope that I brought some awareness to the oftentimes confusing issue around terms like “miscarriage”, “recurrent miscarriage” and “chemical pregnancy”. 

I offer space in the comments below for anyone to share thoughts, feeling and/or experiences of early pregnancy loss.

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