OJOG  Vol.2 No.4 , November 2012
Medical versus surgical treatment for early pregnancy loss in infertile patients: Which approach facilitates more rapid return to subsequent treatment cycle?
ABSTRACT
Patients and physicians confront a challenging dynamic when an early pregnancy loss (EPL) occurs after fertility treatment (FT). Our study focused on the time to resumption of FT in patients managed medically (Cytotec) compared to in those managed surgically with dilatation and curettage (D&C). A retrospective analysis from 2003-2010 of patients receiving treatment for an EPL. Misoprostol (Cytotec) patients were compared with a randomly selected control group (D&C). Both the time from the date of treatment to the date at which βhCG reached <5 mIU/mL and the time until a patient resumed FT was evaluated. We compared the rate of retained product of conception (RPOC) between the 2 groups. Statistical analysis of data was conducted by student-t Test and x2. No statistical significance was observed for resumption of FT between groups. Cytotec group had a greater maintenance of retained products of conception versus D&C population (26% vs 2%; p = 0.01). More D&C patients received karyotype results (68% vs 5%). A significant difference was not found in resumption time to the next fertility treatment between the medically and surgical treatment. More medically managed patients RPOC requiring D&C. Although a D&C is more likely to provide karyotype results, medical management is a viable alternative.

Cite this paper
Vallejo, V. , G. Cotton, H. , A. Lee, J. , Cervantes, E. , Sandler, B. and Copperman, A. (2012) Medical versus surgical treatment for early pregnancy loss in infertile patients: Which approach facilitates more rapid return to subsequent treatment cycle?. Open Journal of Obstetrics and Gynecology, 2, 356-360. doi: 10.4236/ojog.2012.24074.
References
[1]   Dosen, M., Vlaisavljevic, V. and Kovacic, B. (2001) Early miscarriage after single and double blastocyst transfer—An analysis of 1020 blastocyst transfers. Izvirni Clanek, 80, 72-87.

[2]   Chia, K.V. and Ogbo, V.I. (2002) Medical termination of missed abortion. Journal of Obstetrics and Gynaecology, 22, 184-186. doi:10.1080/01443610120113382

[3]   Demtrouslis, C., Saridogan, E., Kunde, D. and Naftalin, A. (2001) A prospective randomized control trial comparing medical and surgical treatment for early pregnancy failure. Human Reproduction, 16, 365-369. doi:10.1093/humrep/16.2.365

[4]   Zhang, J., Gilles, J.M., Barnhart, K., Creinin, D.M., Westhoff, V. and Fredeerick, M.N. (2005) A comparison of medical management with misoprostol and surgical management for early pregnancy failure. New England Journal of Medicine, 353, 761-769. doi:10.1056/NEJMoa044064

[5]   La Sala, G.B., Nucera, G., Galinelli, A., Nicoli, A., Villani, M. and Blickstein, I. (2004) Spontaneous embryonic loss after in vitro fertilization with and without intracytoplasmic sperm injection. Fertility and Sterility, 82, 1536-1539. doi:10.1016/j.fertnstert.2004.04.062

[6]   Winter, E., Wang, J., Davies, M.J. and Norman, R. (2002) Early pregnancy loss following assisted reproductive technology treatment. Human Reproduction, 17, 3220-3223. doi:10.1093/humrep/17.12.3220

[7]   Wang, J.X., Norman, R.J. and Wilcox, A.J. (2004) Incidence of spontaneous abortion among pregnancies produced by assisted reproductive technology. Human Reproduction, 19, 272-277.

[8]   Gronlund, A., Gronlund, L., Clevin, L., Andersen, B., Palmgren, N. and Lidegaard, O. (2002) Management of missed abortion: Comparison of medical treatment with either mifeprostone misoprostol or misoprostol alone with surgical evacuation. Acta Obstetricia et Gynecologica Scandinavica, 81, 1060-1065.

[9]   Chung, T.K.H., Cheung, L.P., Sahota, D.S., Haines, C.J. and Chang, M.Z. (1998) Spontaneous abortion: Short-term complications following either conservative or surgical management. Australian and New Zealand Journal of Obstetrics and Gynaecology, 38, 61-64. doi:10.1111/j.1479-828X.1998.tb02960.x

[10]   Herabutya, Y. and Prasertsawart, P.O. (1997) Misoprostol in the management of missed abortion. International Journal of Gynecology & Obstetrics, 56, 263-266. doi:10.1016/S0020-7292(96)02815-9

[11]   March, C.M. (2011) Management of Asherman’s syndrome. Reproductive BioMedicine Online, 23, 63-76. doi:10.1016/j.rbmo.2010.11.018

[12]   Stockheim, D. and Carp, H. (2010) Misoprostol for early pregnancy failure. Israel Medical Association Journal, 12, 375-376.

[13]   Kulier, R., Gulmezoglu, A.M., Hofmeyr, G.J., Cheng, L.N. and Campana, A. (2004) Medical methods for first trimester abortion. Cochrane Database of Systematic Reviews, 1, CD002855.

[14]   Odeh, M., Tendler, R., Kais, M., Maximovsky, O., Ophir, E. and Bornstein, J. (2010) Early pregnancy failure: Factors affecting successful medical treatment. Israel Medical Association Journal, 12, 325-328.

[15]   Covington, S. and Burns, L. (2006) Infertility counseling: A comprehensive handbook for clinicians. 2nd Edition, Cambridge University Press, New York.

[16]   Brandes, M., Verzijden, J.C.M., Hamilton, C.J.C.M., de Weys, N.P.C., de Bruin, J.P., Bots, R.S.G.M., et al. (2011) Is the fertility treatment itself a risk factor for early pregnancy loss? Reproductive BioMEdicine Online, 22, 192-199. doi:10.1016/j.rbmo.2010.10.013

[17]   Nayak, S., Pavone, M.E., Milad, M. and Kazer, R. (2011) Aneuploidy rates in failed pregnancies following assisted reproductive technology. Journal of Women’s Health, 20, 1239-1243. doi:10.1089/jwh.2010.2648

[18]   Al-Asmar, N., Peinado, V., Vera, M., Remohi, J., Pellicer, A., Simon, C., et al. (2012) Chromosomal abnormalities in embryos from couples with a previous aneuploid miscarriage. Fertility and Sterility, in Press. doi:10.1016/j.fertnstert.2012.03.035

 
 
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