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Purpose <p>Given the absence of evidence-based guidelines specifically addressing early pregnancy loss (EPL) management in IVF populations and the rising global volume of assisted reproductive treatments, there is an urgent clinical need to compare short-term uterine complications and subsequent reproductive outcomes across different management strategies to inform individualized counseling in this high-stakes fertility population.</p> Methods <p>This retrospective cohort study included women with first-trimester early pregnancy loss after in vitro fertilization who were managed at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2015 and December 2022. Patients were classified according to the final completed management strategy: medical management, conventional vacuum aspiration without real-time ultrasound guidance, or ultrasound-guided vacuum aspiration. Inverse probability weighting was used to reduce baseline imbalances among the three groups. Because medical management and conventional vacuum aspiration were the two most frequently used strategies, a supplementary pairwise propensity score–matched analysis was performed to compare these approaches directly. The primary outcome was subsequent live birth. Secondary outcomes included retained products of conception, hysteroscopically detected intrauterine adhesion, pregnancy, clinical pregnancy, subsequent early pregnancy loss, mid-trimester miscarriage, and preterm birth.</p> Results <p>A total of 1,026 women were included, of whom 363 underwent medical management, 577 underwent conventional vacuum aspiration, and 86 underwent ultrasound-guided vacuum aspiration. Before weighting, live birth, retained products of conception, intrauterine adhesion, pregnancy, and clinical pregnancy rates differed significantly among the three groups. After inverse probability weighting, covariate balance generally improved. Weighted analyses showed significant intergroup differences in retained products of conception, clinical pregnancy, and live birth. Retained products of conception were most frequent after medical management and least frequent after ultrasound-guided vacuum aspiration. The weighted rates were 20.5%, 4.9%, and 2.5% in the medical management, conventional vacuum aspiration, and ultrasound-guided vacuum aspiration groups, respectively. Weighted live birth and clinical pregnancy rates were lower in the ultrasound-guided vacuum aspiration group than in the medical management and conventional vacuum aspiration groups; however, this finding should be interpreted cautiously because of the small size of the ultrasound-guided group and potential indication bias. In the propensity score–matched comparison between medical management and conventional vacuum aspiration, medical management was associated with a higher rate of retained products of conception than conventional vacuum aspiration (20.4% vs. 4.2%, <i>P</i> &lt; 0.001), but a lower rate of hysteroscopically detected intrauterine adhesion (8.8% vs. 15.7%, <i>P</i> = 0.01). No statistically significant differences were observed between these two groups in subsequent pregnancy, clinical pregnancy, subsequent early pregnancy loss, mid-trimester miscarriage, preterm birth, or live birth.</p> Conclusions <p>Among women with early pregnancy loss following in vitro fertilization, different management strategies were associated with distinct short-term uterine complication profiles. Medical management was associated with a higher observed rate of retained products of conception, whereas conventional vacuum aspiration was associated with a higher observed rate of hysteroscopically detected intrauterine adhesion in the matched comparison. No statistically significant differences in subsequent reproductive outcomes were observed between medical management and conventional vacuum aspiration; however, these findings should not be interpreted as evidence of equivalence because the study was not designed as an equivalence or non-inferiority study. Ultrasound-guided vacuum aspiration did not show a clear reproductive advantage in this cohort, but this comparison should be considered exploratory because of the limited sample size and potential indication bias. These findings support individualized treatment selection based on residual tissue risk, potential adhesion risk, patient preference, and future fertility plans.</p>

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Short-Term Uterine Complications and Subsequent Reproductive Outcomes After Management of Early Pregnancy Loss Following IVF: A Propensity Score–Weighted and Matched Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月30日

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  • Yangyang Wang,
  • Zhan Shi,
  • Liu Liu,
  • Liaobing Xin,
  • Xiaoying Jin,
  • Xiaomei Tong,
  • Lingling Jiang,
  • Yan Rong,
  • Songying Zhang

摘要

Purpose

Given the absence of evidence-based guidelines specifically addressing early pregnancy loss (EPL) management in IVF populations and the rising global volume of assisted reproductive treatments, there is an urgent clinical need to compare short-term uterine complications and subsequent reproductive outcomes across different management strategies to inform individualized counseling in this high-stakes fertility population.

Methods

This retrospective cohort study included women with first-trimester early pregnancy loss after in vitro fertilization who were managed at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January 2015 and December 2022. Patients were classified according to the final completed management strategy: medical management, conventional vacuum aspiration without real-time ultrasound guidance, or ultrasound-guided vacuum aspiration. Inverse probability weighting was used to reduce baseline imbalances among the three groups. Because medical management and conventional vacuum aspiration were the two most frequently used strategies, a supplementary pairwise propensity score–matched analysis was performed to compare these approaches directly. The primary outcome was subsequent live birth. Secondary outcomes included retained products of conception, hysteroscopically detected intrauterine adhesion, pregnancy, clinical pregnancy, subsequent early pregnancy loss, mid-trimester miscarriage, and preterm birth.

Results

A total of 1,026 women were included, of whom 363 underwent medical management, 577 underwent conventional vacuum aspiration, and 86 underwent ultrasound-guided vacuum aspiration. Before weighting, live birth, retained products of conception, intrauterine adhesion, pregnancy, and clinical pregnancy rates differed significantly among the three groups. After inverse probability weighting, covariate balance generally improved. Weighted analyses showed significant intergroup differences in retained products of conception, clinical pregnancy, and live birth. Retained products of conception were most frequent after medical management and least frequent after ultrasound-guided vacuum aspiration. The weighted rates were 20.5%, 4.9%, and 2.5% in the medical management, conventional vacuum aspiration, and ultrasound-guided vacuum aspiration groups, respectively. Weighted live birth and clinical pregnancy rates were lower in the ultrasound-guided vacuum aspiration group than in the medical management and conventional vacuum aspiration groups; however, this finding should be interpreted cautiously because of the small size of the ultrasound-guided group and potential indication bias. In the propensity score–matched comparison between medical management and conventional vacuum aspiration, medical management was associated with a higher rate of retained products of conception than conventional vacuum aspiration (20.4% vs. 4.2%, P < 0.001), but a lower rate of hysteroscopically detected intrauterine adhesion (8.8% vs. 15.7%, P = 0.01). No statistically significant differences were observed between these two groups in subsequent pregnancy, clinical pregnancy, subsequent early pregnancy loss, mid-trimester miscarriage, preterm birth, or live birth.

Conclusions

Among women with early pregnancy loss following in vitro fertilization, different management strategies were associated with distinct short-term uterine complication profiles. Medical management was associated with a higher observed rate of retained products of conception, whereas conventional vacuum aspiration was associated with a higher observed rate of hysteroscopically detected intrauterine adhesion in the matched comparison. No statistically significant differences in subsequent reproductive outcomes were observed between medical management and conventional vacuum aspiration; however, these findings should not be interpreted as evidence of equivalence because the study was not designed as an equivalence or non-inferiority study. Ultrasound-guided vacuum aspiration did not show a clear reproductive advantage in this cohort, but this comparison should be considered exploratory because of the limited sample size and potential indication bias. These findings support individualized treatment selection based on residual tissue risk, potential adhesion risk, patient preference, and future fertility plans.