Endometrial Thickness Following Early Miscarriage in IVF Patients – Is There a Preferred Management Approach?

Introduction: Endometrial thickness has been previously shown to positively correlate with implantation and pregnancy rates. Management options for treatment of early miscarriage include expectant management, medical therapy and surgical treatment (dilation and curettage (D&C)). This is the first study to compare consequent endometrial thickness between these approaches.

Aim: To investigate if there is a preferred management approach for treatment of early miscarriage with regards to subsequent endometrial thickness.

Materials and Methods: A retrospective cohort study comprised of 123 patients with early miscarriage following a fresh or frozen-thawed embryo transfer between 2007 and 2016. Patients were managed by either expectant management, medical treatment with vaginal Misoprostol or D&C according to patient`s preference. Data were collected for the miscarriage cycle and at least one consecutive cycle. Analysis included evaluation of endometrial thickness alteration in following cycles between the different groups.

Results: Patients who underwent D&C exhibited a significant reduction in endometrial thickness in the consecutive cycle compared with the expectant management and Misoprostol groups (-1.39 mm vs. -0.30 mm and 0.01 mm; p=0.02 for both). A significantly higher incidence of more than 2 mm reduction was shown in the D&C group compared with the expectant management and Misoprostol groups (41.1% vs.15.6% and 14.3%, respectively; p<0.05). The percentage of patients exhibiting a reduction in endometrial thickness in the consecutive IVF cycle was higher in the D&C group (71.3% vs. 53.0% and 56.9%, respectively, NS).

Conclusions: D&C negatively effects endometrial thickness in consecutive IVF cycles compared with expectant management or Misoprostol treatment.