Management of early pregnancy loss by reproductive endocrinologists: Does access to mifepristone matter?

Objective To describe patterns and variations in the medical and procedural management of early pregnancy loss among Reproductive Endocrinology and Infertility (REI) specialists, with attention to mifepristone use. Design Cross-sectional Setting Online survey Subjects Society for Reproductive Endocrinology and Infertility members Main Outcome Measure Preferred management for early pregnancy loss Results Of 101 completed surveys (response rate: 12.2%), 70.3% of respondents reported diagnosing early pregnancy loss at least once per week. Half (50.5%) of respondents preferred medical management as compared to 27.7% who preferred procedural management and 21.8% who preferred expectant management. Approximately one-quarter (26.7%) of respondents offer mifepristone for medical management of early pregnancy loss. The most common reason cited for not prescribing mifepristone was a lack of access to the medication. Mifepristone prescribers were more likely to work in a hospital or university setting than private practice (p = 0.002). Increasing years in practice was also associated with Mifepristone use (p = 0.03). The use of mifepristone for early pregnancy loss did not vary by the respondent’s age, gender, prior abortion training, or practice region. Conclusion The most effective method of medical management uses both mifepristone and misoprostol. However, nearly three-quarters of REI physicians do not offer mifepristone, which may be linked to access issues.