Medical Treatment for Earl Pregnancy Loss Following In Vitro Fertilization Compared to Spontaneous Pregnancies: a Retrospective Study

Abstract Background: Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70-90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was 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. This is a retrospective cohort study. Methods: All women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020 were included. The cohort was divided into two groups: IVF and spontaneous pregnancies.Treatment failure was defined as any surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of gestation. Baseline characteristics and failure rates were compared between the groups.Results: Overall, 775 patients were included, of which 195 (25.1%) ultimately required surgical intervention. There was no difference between the groups in the rate of treatment failure. However, among the IVF group, the rate of emergency D&C was lower (3.6% vs. 9.8%, p=0.001) compared to the spontaneous group. Conclusion: In cases of medical treatment for EPL, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies. Overall, there are no differences in rates of treatment failure between IVF and spontaneous pregnancies.