ObjectiveTo compare medication abortion (MAB) success in very early pregnancy (VEP) with mifepristone followed by either one or two doses of misoprostol. Study DesignWe performed a retrospective cohort analysis of VEP MABs from 7/1/2021 to 05/31/2022 treated with mifepristone 200mg oral followed by a single dose of misoprostol 800mcg buccal 24-48 hours later and MABs from 06/21/2022 to 10/31/2022 treated with mifepristone 200mg oral followed by two doses of misoprostol 800mcg buccal spaced four hours apart, with first dose taken 24-48 hours after mifepristone. Serum BhCG was collected at the time of mifepristone treatment with additional BhCG collected 48-72 hours after misoprostol treatment in both groups. Success was defined as a BhCG decline of > or = 50%. MAB failure was defined as ongoing, viable pregnancy determined by follow up ultrasound or procedural intervention with aspiration. ResultsThere were 423 patients in the single dose misoprostol group and 262 patients in the two-dose misoprostol group. There were no significant differences between the two groups in baseline characteristics. In the single dose group, 372 (87.9%) were treated successfully; in the two-dose group, 224 (85.5%) were treated successfully. There was no significant difference in MAB success between the groups (p=0.73). ConclusionThe addition of a second dose of misoprostol does not improve the success of MAB in VEP. Clinical Trial Registration NumberN/A