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Medical treatment for early pregnancy loss following in vitro fertilization compared to spontaneous pregnancies

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70 and 90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was previously reported that medical treatment was especially successful among women who conceived after in vitro fertilization (IVF).

We aimed to study if there is a difference in rates of medical treatment failures for EPL between pregnancies conceived by IVF and spontaneous pregnancies.

Methods

In this retrospective cohort study, we included all women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020. Treatment outcome was compared between IVF and spontaneous pregnancies. Treatment failure was defined as a need for surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of conception, which was defined as a gestational sac or endometrial thickness greater than 15 mm in a TVS scan.

Results

Overall, 775 patients were included, of which 195 (169/775 = 25.1%) ultimately required surgical intervention. There was no difference between the study groups in the rate of treatment failure. However, among IVF pregnancies, the rate of emergency D&C was lower (3.6% vs. 9.8%, p = 0.001), compared to spontaneous group.

Conclusion

In cases of medical treatment for EPL, IVF pregnancies had no differences in rates of treatment failure compared to spontaneous pregnancies. That being said, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

EPL:

Early pregnancy loss

IVF:

In vitro fertilization

D&C:

Dilation and curettage

RPC:

Retained products of conception

GA:

Gestational age

US:

Ultrasound

BMI:

Body mass index

TVS:

Transvaginal sonography

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Acknowledgements

Meir Azran, Computing and Information Systems, E. Wolfson Medical Center, Holon, Israel. Ela Smirin, archive, E. Wolfson Medical Center, Holon, Israel.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O. Box 5, 58100, Holon, Israel

    Ohad Gluck, Elad Barber, Matan Friedman, Ohad Feldstein, Ori Tal, Ehud Grinstein, Ram Kerner, Eran Weiner & Ron Sagiv

  2. School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ohad Gluck, Elad Barber, Matan Friedman, Ohad Feldstein, Ori Tal, Ehud Grinstein, Ram Kerner, Mai Menasherof, Michal Saidian, Eran Weiner & Ron Sagiv

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  1. Ohad Gluck
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Contributions

O. G. conceptualized and managed the study, and wrote the manuscript O. F. collected data and was in charge on methodology and project administration; E. B. collected data and was in charge on data curation; O. T. collected data and participated in project administration; M. F. collected data and participated in project administration E. G. performed formal analysis, and review; R. K. was involved in data curation and validation; M. M. performed analysis and collected data; M. S. was involved in methodology, and validated data; E. W. was in charge of formal analysis, and drafted the tables; R. S. conceptualized and wrote. All authors reviewed the manuscript.

Corresponding author

Correspondence to Matan Friedman.

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Conflict of interest

The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication.

Ethical approval and consent to participate

The study was approved by the Edith Wolfson Review Board (approval number WOMC-0004-20, approval date 11.2.20). The need of informed consent was waived by IRB of Edith Wolfson Review Board. All methods were carried out in accordance with relevant guidelines and regulations.

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Gluck, O., Barber, E., Friedman, M. et al. Medical treatment for early pregnancy loss following in vitro fertilization compared to spontaneous pregnancies. Arch Gynecol Obstet 309, 2137–2141 (2024). https://doi.org/10.1007/s00404-024-07423-3

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