Management of Early Pregnancy Loss: Reproductive Outcome in Subsequent Euploid Embryo Transfers

Early pregnancy loss (EPL) is commonly managed with medical or surgical intervention, with comparable outcomes described in the general population. However, intrauterine instrumentation including dilation and curettage has been linked to endometrial thinning, associated with inferior in vitro fertilization (IVF) outcomes. Limited data exists on how EPL management influences subsequent IVF outcomes, particular in patients undergoing single euploid embryo transfer (SEET). This single-center, retrospective cohort study compared endometrial thickness and outcomes in the subsequent SEET cycle between patients with EPL who underwent either medical or surgical management. A total of 203 patients were included: 88 patients who underwent medical and 115 who underwent surgical management. The primary outcome was change in endometrial thickness between the initial and subsequent SEET cycle. Secondary outcomes included SEET cycle cancellation due to thin endometrium (< 7 mm) and subsequent SEET outcomes. Between the initial and subsequent SEET cycle, change in endometrial thickness was similar between groups (Medical + 0.3 ± 1.4 mm, Surgical + 0.1 ± 1.5 mm; P = 0.65). Endometrial thickness in the subsequent cycle was also comparable (Medical 9.4 ± 1.5 mm, Surgical 9.1 ± 1.2 mm; P = 0.20). SEET cycle cancellation due to thin endometrium was low and similar between groups (Medical 3.4% [95% CI 1.0-9.6] (n = 3), Surgical 2.6% [95% CI 1.0-7.4] (n = 3); P = 0.74). While surgical management was associated with higher subsequent clinical pregnancy loss (15.7% vs. 4.9%; P < 0.05; aOR 3.72 [95% CI 1.11-12.47]), subsequent live birth rates were similar between groups (Medical 48.8%, Surgical 40.7%; P = 0.27; aOR 0.67 [95% CI 0.35-1.28]). These findings may help guide counseling patients undergoing IVF regarding management decision-making when facing EPL.