treatment of miscarriage
I’d like a job that only involves delivering good news to people. No negative news. The CRA employee who tells people about larger than expected tax refunds or the dog breeder who tells you about the birth of your new puppy.
In health care, most jobs involve sharing good news and bad news with people. The bad news in fertility care is:
- Your eggs or sperm are not healthy enough to make a child
- You have no useable embryos
- You are not pregnant
- You are having a miscarriage
We tell people about miscarriage if the beta HCG blood levels are not rising they way they should or we do not see a healthy fetus on ultrasound. If the miscarriage is diagnosed just based on an abnormally rising beta HCG blood level, then the management is typically just to wait for the period to begin. The period will often be heavier and longer than usual. If the diagnosis of miscarriage is made with ultrasound then treatment decisions are discussed. The possibly management options for later first trimester miscarriages are:
- Expectant management, or “wait and see”
- Medical management (e.g. mifegymiso)
There are pros and cons to each option. D&C comes with a 95% success rate of clearing the uterus, but involves surgery and the (small) risk of infection, uterine perforation and bleeding. Mifegymiso is more painful and the success rate of clearing the uterus that is is lower at about 85%. Expectant management is even less successful.
A recent publication in Fertility & Sterility reassures us that there is no wrong choice of treatment, with respect to furture fertility. This study examined pregnancy rates at 6 months after medical or surgical (D&C) management of miscarriage and found similar rates: 68% of women who underwent medical management and 65% of those who had surgical management were pregnant again.
Most of our patients are Olive who miscarry opt for medical management for the advantages of privacy, low intervention, self-scheduling, and the avoidance of the (small) surgical risks of D&C. For many reasons, including further pregnancy rates, this is a good choice.
While a miscarriage is a devastating outcome of a desperately wanted pregnant, the small bit of good news we can share is that there is a good chance of a pregnancy in the following months, no matter what treatment is chosen,.
Reference: Tzur Y, Samueloff O, Raz Y, Bar-On S, Laskov I, Tzur T. Conception rates after medical versus surgical evacuation of early miscarriage. Fertil Steril. 2021 Jan;115(1):118-124.
Reproductive Endocrinology & Infertility