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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
Article info
Publication history
Accepted:
January 17,
2023
Received in revised form:
January 12,
2023
Received:
September 30,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
Funding Statement: There is no funding for this work
Disclosures: None of the authors have relationships/activity/interests related to this work.
Attestation statements: The subjects in this trial have not concomitantly been involved in other randomized trials. Data regarding any of the subjects in the study has not been previously published unless specified. Data will be made available to the editors of the journal for review or query upon request.
Identification
Copyright
© 2023 The Authors. Published by Elsevier Inc. on behalf of American Society for Reproductive Medicine.
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