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Mifepristone-Misoprostol Combination Treatment for Early Pregnancy Loss Following Embryo Transfer: A Case Series

Open AccessPublished:January 19, 2023DOI:https://doi.org/10.1016/j.xfre.2023.01.003
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      ABSTRACT

      Objective

      Evidence strongly supports the use of mifepristone-misoprostol combination treatment for early pregnancy loss (EPL) among pregnancies conceived without assisted reproductive technologies (ART). No literature exists, however, regarding the efficacy of this treatment in the medical management of EPL among pregnancies following in vitro fertilization and embryo transfer (IVF-ET). These patients differ as some utilize exogenous hormonal supplementation to provide pregnancy support. Thus, the management for EPL may differ between unassisted conceptions and those following ET. Mifepristone, a progesterone receptor antagonist, may demonstrate an altered treatment effect when used with misoprostol to manage EPL in ART-conceived pregnancies.

      Objective

      To describe our institution’s experience using mifepristone-misoprostol to manage early pregnancy loss (EPL) following in vitro fertilization with embryo transfer (IVF-ET).

      Design

      Retrospective Case Series

      Setting

      Single academic institution from 2020–2022.

      Patients(s)

      Nine patients with ultrasound confirmed EPL following IVF-ET.

      Intervention(s)

      All 9 patients underwent in vitro fertilization followed by fresh or frozen embryo transfer. All 9 received 200 mg of mifepristone 24 hours prior to 800 mcg of misoprostol.

      Main Outcome Measurement(s)

      Incomplete abortion, need for surgical management, number of days to negative serum hCG.

      Results

      Of the 9 subjects included, 1 had a programmed FET cycle, 6 had modified natural FET cycles, and 2 underwent fresh ET. Eight subjects had successful expulsion of tissue with 1 dose of treatment, and 1 required uterine aspiration. No subjects required additional dosing of misoprostol. The mean number of days elapsed from mifepristone treatment to tissue expulsion was 4.89 ± 11.30 days, and mean days to negative-range serum hCG was 36.89 ± 18.59 days. At initial ultrasound, all pregnancies had 1 gestational sac seen; 5/9 had a yolk sac; only 3 had fetal cardiac activity. The mean gestational age at time of EPL diagnosis was 55.22 ± 8.77 days, with the majority (8/9) having completed 7 weeks gestation.

      Conclusions

      Mifepristone-misoprostol combination treatment appears to be a reasonable option for those with EPL following IVF-ET. Future, larger studies comparing combination treatment to misoprostol only among various ET protocols are needed.

      Key Words