When everything seems to be going smoothly after an embryo transfer—HCG levels are rising, and excitement is high—unexpected bleeding can feel terrifying. Many intended parents have described that moment of hearing “the surrogate is bleeding” as one of the most frightening parts of the journey.
The good news: not all bleeding means miscarriage. In fact, one of the most common causes of bleeding in early pregnancy is something called a subchorionic hematoma (SCH). Let’s take a closer look at what it means, why it happens, and what surrogates and intended parents should know.
What Is a Subchorionic Hematoma (SCH)?
A subchorionic hematoma—sometimes called subchorionic bleeding—happens when blood collects between the uterine wall and the chorion (the outer membrane around the gestational sac).
This pocket of blood can be small or large, and sometimes it is only detected on an ultrasound.
Why Does SCH Happen?
SCH occurs when the chorion partially separates from the uterine lining, allowing blood to pool in that space.
Doctors don’t always know the exact reason why it develops, but certain factors may increase the likelihood:
- IVF pregnancies, especially after fresh embryo transfers
- Hormone-programmed frozen embryo transfers (higher incidence than natural-cycle FET)
- Uterine structural abnormalities or scarring
- Polycystic ovary syndrome (PCOS) or hydrosalpinx
- Previous miscarriage or uterine trauma
How Common Is It in IVF Pregnancies?
SCH is more common in IVF pregnancies than in natural conception. Large studies have reported rates around 18–27% after embryo transfer, with higher rates in fresh and medicated cycles compared to natural-cycle transfers.
A recent 2024 study of IVF pregnancies even found SCH in about 1 out of 5 women after euploid embryo transfer.
Symptoms and When to Worry
The most common symptom is vaginal bleeding or spotting, which can range from light pink discharge to heavier bleeding. Some women also experience cramping.
However, many SCH cases are silent—detected only on routine ultrasound.
Seek immediate medical attention if:
- Bleeding is heavy (soaking a pad in an hour)
- Severe abdominal pain or cramping occurs
- Dizziness, fainting, or shoulder pain develops
How Long Does It Last?
The duration varies. Many hematomas shrink and resolve on their own within a few weeks. Smaller SCH often disappear without intervention, while larger ones may take longer but still resolve in most cases.
How SCH Is Diagnosed
An ultrasound is the main diagnostic tool. Doctors look at the size and location of the hematoma. Blood tests (such as HCG and progesterone levels) may also be checked to confirm overall pregnancy health.
Management and Treatment Options
There is no universal treatment for SCH, but doctors may recommend:
- Activity modification: reduced exertion, pelvic rest, avoiding intercourse
- Regular ultrasounds: to monitor changes in the hematoma
- Progesterone support: commonly used in IVF, sometimes considered protective
- Close communication: with the fertility clinic and OB team
Most cases are managed with observation and reassurance rather than aggressive intervention.
Does SCH Affect IVF Pregnancy Outcomes?
This is an area where research has shown mixed results:
- Some studies (e.g., Anderson 2020, Yin 2022, Wei 2025) found that SCH in IVF pregnancies did not significantly affect live birth rates, preterm delivery, or infant health.
- Other recent studies (e.g., Wang 2024 with euploid embryos) reported that SCH was associated with a higher risk of early miscarriage and a slightly lower live birth rate.
- Importantly, the presence of vaginal bleeding alongside SCH seems to be a more consistent risk factor for complications than the hematoma itself.
- Hematoma size alone has not been consistently linked to miscarriage risk in IVF pregnancies, although very large SCH may increase the risk of placental abruption later in pregnancy.
Overall, while SCH is more common after IVF, many women with SCH go on to deliver healthy babies.
Other Causes of Early Pregnancy Bleeding
Not all bleeding is due to SCH. Other possible causes include:
- Implantation bleeding – when the embryo attaches to the uterine lining
- Cervical changes – increased blood flow can cause light bleeding
- Ectopic pregnancy – implantation outside the uterus (medical emergency)
- Miscarriage – often accompanied by heavier bleeding and cramping
Emotional Impact: For Surrogates and Intended Parents
Even if SCH is usually not dangerous, the anxiety it creates is very real.
- For surrogates: It can be stressful to report bleeding, worrying how the intended parents will react.
- For intended parents: After investing so much in IVF, unexpected bleeding can feel devastating.
Clear communication, medical reassurance, and remembering that most SCH cases resolve without harm can help ease the stress.
Key Takeaways
- SCH is common in IVF pregnancies, with incidence around 18–27%, especially in fresh and medicated cycles.
- Most SCHs resolve naturally and do not cause lasting harm to the baby.
- Evidence is mixed: some studies show no adverse impact on live birth rates, while others report a higher risk of miscarriage, especially if diagnosed very early or accompanied by bleeding.
- Size matters less than symptoms: the presence of bleeding with SCH is more predictive of risk than hematoma size.
- Progesterone support may help: some studies suggest dydrogesterone or other progesterone may lower miscarriage risk, though guidelines are not yet definitive.
- For surrogates and intended parents: stay calm, follow medical advice, and maintain close monitoring—most pregnancies with SCH continue to term with healthy outcomes.
Frequently Asked Questions (FAQ)
1. Does a subchorionic hematoma always mean miscarriage?
No. While some recent IVF studies suggest SCH may modestly increase the risk of miscarriage, the majority of women with SCH—especially those who reach the second trimester—go on to deliver healthy babies.
2. Is SCH more common in IVF pregnancies than in natural pregnancies?
Yes. Research shows that SCH occurs in 18–27% of IVF pregnancies, compared with ~13% in spontaneous conceptions.
3. Does the size of the hematoma affect outcomes?
Not consistently. Most IVF studies found size was not strongly linked to miscarriage risk. What matters more is the presence of vaginal bleeding.
4. What if the surrogate has bleeding but ultrasound shows the baby is fine?
If ultrasound shows a heartbeat and a stable pregnancy, the outlook is often good. Many hematomas shrink and disappear over time.
5. Do surrogates need strict bed rest if they have SCH?
Not usually. Doctors may suggest pelvic rest and avoiding strenuous activity, but complete bed rest has not been shown to improve outcomes.
6. Can medication help treat SCH?
No universal medication exists. In IVF pregnancies, progesterone support is already standard and may provide a protective effect.
7. Does SCH affect twin IVF pregnancies differently?
Yes. Studies show higher miscarriage risk in twin IVF pregnancies with SCH, so closer monitoring is needed.
8. When should we call the doctor or go to the ER?
- Heavy bleeding (soaking a pad in an hour)
- Severe abdominal pain or cramping
- Dizziness, fainting, or shoulder pain
References
- Anderson K, et al. Outcomes of IVF pregnancies complicated by subchorionic hematoma. F&S Reports. 2020.
- Reich H, et al. Incidence of SCH in natural vs medicated FET cycles. Fertility and Sterility. 2020.
- Ma L, et al. Nomogram for predicting SCH risk in IVF pregnancies. Front Endocrinol. 2021.
- Yin T, et al. Impact of SCH on pregnancy outcomes in IVF singletons. Arch Gynecol Obstet. 2022.
- Mei Y, et al. SCH in IVF twin pregnancies. Front Med. 2023.
- Wang W, et al. Impact of first-trimester SCH after euploid embryo transfer. BMC Pregnancy Childbirth. 2024.
- Yan J, et al. First-trimester SCH and pregnancy outcomes: meta-analysis. AJOG MFM. 2023.
- Wei Q, et al. Higher SCH incidence in IVF vs natural conception, but no outcome difference. Front Med. 2025.
Ready to Talk to Our Team?
At Ivy Surrogacy, we understand that hearing about subchorionic hematoma can feel overwhelming for both surrogates and intended parents. Our team combines deep medical expertise with compassionate support, guiding you through every step of the journey.
👉 If you have questions about SCH, IVF pregnancies, or the surrogacy process, we are here to help.
