Management of early pregnancy loss with mifepristone and misoprostol: clinical predictors of treatment success from a randomized trial

Abstract

OBJECTIVE: Serum biomarkers of ovarian reserve have been utilized in non-RPL cohorts to stratify patients who may benefit from PGT-A. The goal of this study was to determine if AMH levels are predictive of outcomes in RPL patients pursuing PGT-A. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Unexplained RPL patients undergoing PGT-A at two fertility centers from 2009-2018 were included. All patients with the intent to perform PGT-A (trophectoderm biopsy and 24 chromosome screening) were included regardless of final cycle outcome. Pregnancy loss was defined as loss of pregnancy from conception (bHCG level >5mIU/ mL) through twenty weeks gestation. RESULTS: 157 patients underwent 191 retrievals (RET), 146 of which completed PGT-A. Patient demographics and outcomes stratified by AMH<1 ng/mL and AMH R1 ng/mL are shown in Table 1. Patients with AMH < 1 ng/mL were significantly older with similar BMI and number of prior losses compared to patients with AMH R1 ng/mL. Patients with AMH <1 ng/mL had fewer oocytes (p<0.01) and a higher average aneuploidy rate (p¼0.02) compared to patients with AMH R1 ng/mL. In a regression model adjusting for age, AMH is not a significant predictor of having at least one euploid blastocyst (p¼0.10, CI 0.97-1.43), reaching ET (p¼0.97, CI 0.84-1.18), achieving pregnancy (p¼0.42, CI 0.82-1.09), achieving live birth (p¼0.12, CI 0.86-1.02) or undergoing pregnancy loss (p¼0.42, CI 0.90-.28). CONCLUSIONS: Although ovarian reserve is associated with IVF success rates, we report that RPL patients with diminished ovarian reserve (DOR) have similar likelihood of achieving pregnancy and live birth with PGT-A compared to RPL patients with AMH > 1 ng/mL. Future studies should incorporate total cycle potential in evaluation of clinical outcomes and consider a lower AMH cutoff for evaluating DOR. Reference: None. SUPPORT: None.

Clinical Efficacy and Safety Study of Mifepristone with Misoprostol Treatment in Patients with Missed Abortion

“…In addition, it induces uterine contraction by releasing endogenous prostaglandins, which subsequently induce the detachment of the decidua from the uterine wall, softening and dilating the cervix to facilitate the expulsion of intrauterine tissue. As a steroidal structured progesterone receptor antagonist with a very high safety profile, mifepristone has no progestational, androgenic, estrogenic, or antiestrogenic activity and significantly improves the rate of complete abortions in patients [ 15 , 16 ]. Misoprostol is a derivative of prostate E that exerts cervical softening and dilating effects by stimulating the release of various elastase enzymes from cervical fibrous tissue, and it also enhances uterine contraction [ 17 ].…”

Non-linear Relationship of Maternal Age With Risk of Spontaneous Abortion: A Case-Control Study in the China Birth Cohort

“…Spontaneous abortion is defined as fetal loss before 28 gestational weeks (1). Among all pregnant women, the incidence of spontaneous abortion is rising and it is the most common complication in the first trimester (2)(3)(4). The risk of adverse maternal and infant outcomes increases due to advanced maternal age (5).…”

Utility and Limitations of Human Chorionic Gonadotropin Levels for Remote Follow-up After Medical Management of Early Pregnancy Loss

“…Clinical symptomatology including heavy bleeding, passage of tissue, or resolution of pregnancy symptoms may increase the utility of hCG level decline to determine success or failure of medical management of early pregnancy loss. 12…”