Misoprostol Equal to Surgery in Resuming Fertility Treatment after Pregnancy Loss

Fertility is restored after surgical management of a pregnancy loss at the same speed as with medical management, although a significant number of women who are managed medically have retained products of conception (POC), said Hilde Cotton, RN, BSN, a nurse at Reproductive Medicine Associates of New York, New York City, at the 2010 American Society for Repro ductive Medicine meeting.

Nurses fill a crucial counseling role after a pregnancy loss, she said. Couples often cite the compassionate care of the medical staff as having the greatest effect on their course of mourning. “Providers manifest this compassion in considering all options and aiding patients in making a decision based on their individual expectations,” she said.

Pregnancy loss can delay the resumption of fertility treatment, and patients often ask what is the fastest, least-invasive, and easiest method to manage a missed abortion to resume fertility treatment. Each method has advantages and disadvantages.

Surgical management, known as dilation and curettage (D&C), offers the chance to obtain a karyotype of the POC and is quick, but it requires anesthesia and carries the risk of infection and uterine scarring. Medical management with misoprostol avoids anesthesia, can be given at home if needed, and is less expensive than surgical management, but it involves the risks associated with retained POC, as well as painful uterine cramping.

Ms Cotton and colleagues evaluated the effects of misoprostol compared with surgical management in the context of a pregnancy loss. Their study included 63 women who had a pregnancy loss before 10 weeks of gestation. The 19 women who were treated with misoprostol (800 mg vaginally) were compared with the 44 women who underwent D&C.

“There was no significant difference between misoprostol and D&C in the time to treatment resumption,” Ms Cotton said. The time from treatment to the next fertility treatment cycle was 54.5 days with misoprostol and 60.3 days with surgical management.

There were, however, marked differences between the groups for POC retention and karyotype results. A karyotype was obtained in 68% of the patients managed surgically and 5% of those managed medically. Of the women managed with misoprostol, 26% retained POC compared with only 2% of those managed with D&C.

“The study did not confirm the perceived benefit of faster return to fertility treatment for the D&C population,” Ms Cotton said. The data show that misoprostol is a viable option for patients undergoing fertility treatment, although a D&C is more likely to provide karyotyping.