Esposito Leah, Kornfield Molly Siegel, Rubin Elizabeth, O'Leary Thomas, Amato Paula, Lee David, Wu Diana, Krieg Sacha, Parker Pamela B
Oregon Health and Science University School of Medicine, Portland, Oregon.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Health and Science University, Portland, Oregon.
F S Rep. 2023 Jan 20;4(1):93-97. doi: 10.1016/j.xfre.2023.01.003. eCollection 2023 Mar.
Evidence strongly supports the use of mifepristone-misoprostol combination treatment for early pregnancy loss (EPL) among pregnancies conceived without assisted reproductive technologies. No literature exists, however, regarding the efficacy of this treatment in the medical management of EPL among pregnancies after in vitro fertilization and embryo transfer (IVF-ET). These patients differ as some use exogenous hormonal supplementation to provide pregnancy support. Thus, the management for EPL may differ between unassisted conceptions and those after ET. Mifepristone, a progesterone receptor antagonist, may demonstrate an altered treatment effect when used with misoprostol to manage EPL in assisted reproductive technologie-conceived pregnancies.
To describe our institution's experience using mifepristone-misoprostol to manage EPL after in vitro fertilization with embryo transfer IVF-ET.
Retrospective case series.
Single academic institution from 2020 to 2022.
Nine patients with ultrasound confirmed EPL after IVF-ET.
All 9 patients underwent in vitro fertilization followed by fresh or frozen embryo transfer. All 9 received 200 mg of mifepristone 24 hours before 800 μg of misoprostol.
Incomplete abortion, need for surgical management, number of days to negative serum human chorionic gonadotropin (hCG).
Of the 9 subjects included, one had a programmed frozen embryo transfer cycle, 6 had modified natural frozen embryo transfer cycles, and 2 underwent fresh ET. Eight subjects had successful expulsion of tissue with one dose of treatment, and one 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 the mean days to negative-range serum hCG was 36.89 ± 18.59 days. At the initial ultrasound, all pregnancies had one gestational sac seen; 5/9 had a yolk sac; only 3 had fetal cardiac activity. The mean gestational age at the time of EPL diagnosis was 55.22 ± 8.77 days, with the majority (8/9) having completed 7 weeks gestation.
Mifepristone-misoprostol combination treatment appears to be a reasonable option for those with EPL after IVF-ET. Future, larger-scale studies are needed comparing combination treatment with misoprostol only among various ET protocols.
有充分证据支持米非司酮 - 米索前列醇联合治疗用于未采用辅助生殖技术受孕的早期妊娠丢失（EPL）。然而，尚无关于该治疗在体外受精和胚胎移植（IVF - ET）后妊娠的EPL药物治疗疗效的文献。这些患者有所不同，因为一些人使用外源性激素补充来维持妊娠。因此，EPL在自然受孕和胚胎移植后妊娠中的管理可能存在差异。米非司酮是一种孕激素受体拮抗剂，与米索前列醇联合用于辅助生殖技术受孕妊娠的EPL治疗时，可能会表现出不同的治疗效果。
描述我们机构使用米非司酮 - 米索前列醇治疗体外受精胚胎移植（IVF - ET）后早期妊娠丢失的经验。
回顾性病例系列。
2020年至2022年的单一学术机构。
9例经超声确诊为IVF - ET后早期妊娠丢失的患者。
所有9例患者均接受体外受精，随后进行新鲜或冷冻胚胎移植。所有9例患者在服用800μg米索前列醇前24小时均接受200mg米非司酮。
流产不全、手术处理需求、血清人绒毛膜促性腺激素（hCG）转阴天数。
纳入的9名受试者中，1名进行了计划性冷冻胚胎移植周期，6名进行了改良自然冷冻胚胎移植周期，2名进行了新鲜胚胎移植。8名受试者一剂治疗后成功排出组织，1名需要清宫。所有受试者均无需额外服用米索前列醇。从米非司酮治疗到组织排出的平均天数为4.89±11.30天，血清hCG转阴的平均天数为36.89±18.59天。在初次超声检查时，所有妊娠均可见一个妊娠囊；9例中有5例有卵黄囊；只有3例有胎心搏动。EPL诊断时的平均孕周为5
