Bleeding and spontaneous abortion after therapy for infertility

Objective: To determine the incidence of early-pregnancy bleeding and spontaneous abortion (SAB) after various treatments for infertility and to assess whether bleeding is predictive of SAB. Design: An historic cohort study of women who conceived after various treatments. Setting: Hospital- based private practice. Patient(s): We studied 418 patients in whom 500 consecutive clinical pregnancies occurred. Intervention(s): Patients were grouped according to the method of conception: ovulation induction, IVF, and other. The latter category included interventions not requiring ovulation induction, such as surgery and insemination. A fourth group of subjects who conceived independently of treatment was used as the control. Main Outcome Measure(s): Bleeding and pregnancy outcome (SAB, ectopic pregnancy, or ongoing pregnancy). Result(s): Rates of SAB did not differ among the treatment groups. SAB occurred significantly more often after bleeding than when bleeding did not occur (30.8% versus 19.8%, respectively). Bleeding was predictive of SAB only in patients <35 years old (odds ratio 2.4). Conclusion(s): Infertile women who conceive after reproductive therapy are not at increased risk for SAB compared with women who conceive naturally. There appears to be no association between previous diagnosis or treatment and the occurrence of SAB in previously infertile women. Bleeding is associated with a twofold relative risk of SAB. (C) 2000 by American Society for Reproductive Medicine.