Abstract
OBJECTIVE: Pregnancy loss results in not only a loss of a potential baby but also a delay in resuming fertility treatment. Patients who do not pass the products of conception (POC) naturally must decide between medical & surgical management. The surgical option, a Dilatation & Curretage (D&C), provides possible karyotyping of POC, but is invasive and carries the risk of uterine scarring. Medical management with misoprostol presents a viable alternative, although it may delay subsequent fertility treatment. We compared the time to resumption of fertility treatment in patients treated with misoprostol vs. D&C.DESIGN: Retrospective data analysis.MATERIALS AND METHODS: Patients treated with misoprostol (800mg per vagina) from 2003-2010 were compared with a control group of patients undergoing D&C. Time to reach a negative serum βhCG and to the next fertility treatment were calculated. The rate of known retained POC was also analyzed. Student-t test and χ2 were used.Tabled 1D&C (n=44)Misoprostol (n=19)p valueTreatment to Negative βhCG37.2 ± 16.037.7 ± 15.0NSTreatment to Next Cycle54.5 ± 19.560.3 ± 42.4NSRetained POC2%26%<0.05Karyotype Obtained68%5%<0.05 Open table in a new tab CONCLUSION: We did not confirm a perceived benefit of faster return to fertility treatment for surgically managed patients. While medical treatment did not delay the average time, a significant number of patients suffered from retained POC and required a D&C. It is important for providers to discuss with their patients the benefits and risks associated with both treatments. Although a D&C is more likely to provide POC for karyotyping, medical management of miscarriage is a viable alternative in patients undergoing reproductive treatment. OBJECTIVE: Pregnancy loss results in not only a loss of a potential baby but also a delay in resuming fertility treatment. Patients who do not pass the products of conception (POC) naturally must decide between medical & surgical management. The surgical option, a Dilatation & Curretage (D&C), provides possible karyotyping of POC, but is invasive and carries the risk of uterine scarring. Medical management with misoprostol presents a viable alternative, although it may delay subsequent fertility treatment. We compared the time to resumption of fertility treatment in patients treated with misoprostol vs. D&C. DESIGN: Retrospective data analysis. MATERIALS AND METHODS: Patients treated with misoprostol (800mg per vagina) from 2003-2010 were compared with a control group of patients undergoing D&C. Time to reach a negative serum βhCG and to the next fertility treatment were calculated. The rate of known retained POC was also analyzed. Student-t test and χ2 were used. CONCLUSION: We did not confirm a perceived benefit of faster return to fertility treatment for surgically managed patients. While medical treatment did not delay the average time, a significant number of patients suffered from retained POC and required a D&C. It is important for providers to discuss with their patients the benefits and risks associated with both treatments. Although a D&C is more likely to provide POC for karyotyping, medical management of miscarriage is a viable alternative in patients undergoing reproductive treatment.
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