Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (2): 69-74.doi: 10.6040/j.issn.1671-7554.0.2023.1063

• Clinical Medicine • Previous Articles    

Comparison of medical abortion and surgical abortion in the management of missed abortion after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer

ZHAO Shengrui1,2,3, QU Huiling1,2,3, XU Xinxin1,2, ZHANG Fangfang1,2, YAN Lei1,2,3   

  1. 1. Reproductive Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China;
    2. Institute of Women, Children and Reproductive Health, Shandong University, Jinan 250012, Shandong, China;
    3. Medical Integration and Practice Center, Shandong University, Jinan 250012, Shandong, China
  • Published:2024-03-29

Abstract: Objective To compare the efficacy of medical abortion and surgical abortion in the management of missed abortion after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)and their effects on the pregnancy outcomes of subsequent embryo transfer. Methods Patients with missed abortion after IVF/ICSI-ET with gestation weeks less than 13 weeks, treated in the Reproductive Hospital Affiliated to Shandong University during Jan. 2016 and Jan. 2017 were selected and divided into medical group(n=134)and surgical group(n=130)according to random number table method. The success rate of abortion, changes of endometrial thickness before and after abortion, and the pregnancy outcomes of the first embryo transfer after abortion were observed. Results The success rate of surgiacal abortion was significantly higher than that of medical abortion(99.23% vs. 85.35%, P<0.001). The endometrial thickness before embryo transfer on the human chorionic gonadotropin(HCG)day was higher in the surgical group than in the medical group [(1.01±0.19)cm vs.(1.06±0.20)cm, P=0.040]. Furthermore, there was a great difference in endometrial thickness before and after embryo transfer in the surgical group compared to the medical group[(-0.01±0.17)cm vs.(0.06±0.17)cm, P=0.008]. There were no significant differences in the pregnancy outcomes following the first embryo transfer after abortion between the two groups. Conclusion For missed abortion after IVF/ICSI within 13 weeks of gestation, the efficacy of surgical abortion is higher than that of medical abortion. However, medicine may be more beneficial to endometrial preservation than surgery. The two treatments have no significant impact on the pregnancy outcomes following the first embryo transfer.

Key words: In vitro fertilization, Intracytoplasmic sperm injection, Medical abortion, Surgical abortion, Pregnancy outcome, Endometrial thickness

CLC Number: 

  • R714.21
[1] Magnus MC, Wilcox AJ, Morken NH, et al. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study[J]. BMJ, 2019, 364: l869. doi: 10.1136/bmj.l869.
[2] 胡凤贤. 药物流产与人工流产终止早孕效果的临床效果比照观察[J]. 中国医药指南, 2020, 18(1): 159-160.
[3] Tamir R, Allouche S, Weissman A, et al. The effect of medical versus surgical treatment of spontaneous miscarriage on subsequent in vitro fertilization cycles[J]. Gynecol Endocrinol, 2016, 32(3): 231-233.
[4] Ghosh J, Papadopoulou A, Devall AJ, et al. Methods for managing miscarriage: a network meta-analysis[J]. Cochrane Database Syst Rev, 2021, 6(6): CD012602. doi: 10.1002/14651858.CD012602.pub2.
[5] 汪东霞, 王秀中, 唐伟娜. 剖宫产术后早孕人工流产与药物流产治疗效果比较[J]. 中国医药科学, 2019, 9(6): 117-119. WANG Dongxia, WANG Xiuzhong, TANG Weina. Study and comparison of curative effect of induced abortion and medical abortion in early pregnancy after cesarean section[J]. China Medicine and Pharmacy, 2019, 9(6): 117-119.
[6] Nagendra D, Gutman SM, Koelper NC, et al. Medical management of early pregnancy loss is cost-effective compared with office uterine aspiration[J]. Am J Obstet Gynecol, 2022, 227(5): 737.e1-737.e11.
[7] 卢晓敏. 药物流产与人工流产终止早孕的效果比较[J]. 中国现代药物应用, 2021, 15(14): 94-96.
[8] Wang Y, Sun Y, Di W, et al. Association between induced abortion history and later in vitro fertilization outcomes[J]. Int J Gynaecol Obstet, 2018, 141(3): 321-326.
[9] Meng J, Zhu M, Shen W, et al. Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study[J]. BMC Pregnancy Childbirth, 2019, 19(1): 409. doi:10.1186/s12884-019-2543-9.
[10] 高宏英. 药物流产与人工流产终止早孕效果的临床效果比照观察[J]. 中国医药指南, 2019, 17(36): 139-140.
[11] Musik T, Grimm J, Juhasz-Böss I, et al. Treatment options after a diagnosis of early miscarriage: expectant, medical, and surgical[J]. Dtsch Arztebl Int, 2021, 118(46): 789-794.
[12] 王春兰. 药物流产与无痛人工流产的临床治疗效果及安全性评价[J]. 中国实用医药, 2019, 14(30): 46-47.
[13] 王凤莲. 药物流产与人工流产终止早孕的效果及对阴道出血量的影响[J]. 中国医药指南, 2021, 19(12): 26-27. WANG Fenglian. Effect of drug abortion and induced abortion on termination of early pregnancy and its influence on the amount of vaginal bleeding[J]. Guide of China Medicine, 2021, 19(12): 26-27.
[14] Zhang J, Zhou K, Shan D, et al. Medical methods for first trimester abortion[J]. Cochrane Database Syst Rev, 2022, 5(5): CD002855. doi: 10.1002/14651858.CD002855.pub5.
[15] 方芳, 许琳玲, 仇茜, 等. 药物流产与无痛人工流产对育龄期妇女凝血功能、性激素水平及月经功能恢复的影响[J]. 临床和实验医学杂志, 2022, 21(1): 72-76. FANG Fang, XU Linling, QIU Qian, et al. Effects of medical abortion and painless abortion on coagulation function, sex hormone level and menstrual function recovery in women of childbearing age[J]. Journal of Clinical and Experimental Medicine, 2022, 21(1): 72-76.
[16] 汤慧敏, 秦真岳, 董智勇, 等. 以雌孕激素序贯疗法为基础的联合药物方案治疗不全流产的疗效分析[J]. 生殖医学杂志, 2023, 32(11): 1687-1692. TANG Huimin, QIN Zhenyue, DONG Zhiyong, et al. Analysis of therapeutic effect of a combined medication regimen based on sequential estrogen and progesterone therapy for incomplete abortion[J]. Journal of Reproductive Medicine, 2023, 32(11): 1687-1692.
[17] American College of Obstetricians and Gynecologists Committee on Practice Bulletins-Gynecology, Society of Family Planning. Medication abortion up to 70 days of gestation: ACOG practice bulletin, Number 225[J]. Obstet Gynecol, 2020, 136(4): e31-e47.
[18] Karavani G, Alexandroni H, Sheinin D, et al. Endometrial thickness following early miscarriage in IVF patients-is there a preferred management approach?[J]. Reprod Biol Endocrinol, 2021, 19(1): 93. doi: 10.1186/s12958-021-00780-7.
[19] 高欣艳, 卢少明, 颜磊. 体外受精-胚胎移植早期稽留流产方式对下次冻胚移植结局的影响[J]. 现代妇产科进展, 2020, 29(12): 925-927.
[20] Gan C, Zou Y, Wu S, et al. The influence of medical abortion compared with surgical abortion on subsequent pregnancy outcome[J]. Int J Gynaecol Obstet, 2008, 101(3): 231-238.
[21] Tzur Y, Samueloff O, Raz Y, et al. Conception rates after medical versus surgical evacuation of early miscarriage[J]. Fertil Steril, 2021, 115(1): 118-124.
[22] Sacks D, Baxter B, Campbell BCV, et al. Multisociety consensus quality improvement revised consensus statement for endovascular therapy of acute ischemic stroke[J]. Int J Stroke, 2018, 13(6): 612-632.
[23] 王巧英, 张晓凤. 妊娠期妇女发生早期自然流产的相关因素分析[J]. 中国妇幼保健, 2015, 30(3): 407-409.
[24] World Health Organization. Abortion care guideline[M]. Geneva: World Health Organization, 2022.
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