Type Of Treatment For Miscarriage Does Not Have An Effect On Long Term Fertility

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Main Category: Women's Health / Gynecology
Also Included In: Fertility
Article Date: 09 Oct 2009 - 0:00 PDT

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A study published on bmj.com today reports that the type of treatment a woman receives after an early miscarriage does not affect subsequent fertility. Around 80 percent of women have a live birth within five years of their miscarriage.

It is established that fifteen per cent of pregnancies end in early miscarriage. For decades the typical management of early miscarriage was surgical evacuation of retained products of conception. However, this was increasingly questioned. Now women are usually offered expectant (watch and wait) and medical management as well.

Earlier studies, including the largest published trial (the MIST trial), have indicated that all three methods are probably similar in terms of gynecological infection. However, the long term effects on fertility are unknown.

Researchers based in the South West of England decided to compare fertility rates for the three management methods (expectant, medical or surgical).

A total of 762 women who had taken part in the original MIST study were surveyed. They had randomly received surgical, medical or expectant management for an early miscarriage (less than 13 weeks gestation).

These women answered a questionnaire about the succeeding pregnancies and live births after this miscarriage. The age factor, previous miscarriage and previous birth history were considered.

Among the survey respondents, 83.6 percent reported a subsequent pregnancy, with 82 percent having a live birth.

The time to subsequently give birth was very similar in the three management groups: 79 percent of those randomized to expectant management, 78.7 percent of the medical group and 81.7 percent of the surgical group, all had a live birth five years after their miscarriage.

On the other hand, older women and those suffering three or more miscarriages had considerably less probabilities to subsequently give birth.

In closing, the authors confirm that the method of miscarriage management does not affect subsequent pregnancy rates. In addition, around four in five women have a live birth within five years of a miscarriage.

They write: "Women can be reassured that long term fertility concerns need not affect their choice of miscarriage, management method."

"Incidence of pregnancy after expectant, medical, or surgical management of spontaneous first trimester miscarriage: long term follow-up of miscarriage treatment (MIST) randomised controlled trial"
Lindsay F P Smith, research lead, Paul D Ewings, director of Peninsula RDSU, Catherine Quinlan, research administrator
BMJ 2009; 339:b3827
doi:10.1136/bmj.b3827
bmj.com

Written by Stephanie Brunner (B.A.)
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