LAUSR

ABSTRACT Purpose To investigate how two methods for managing early miscarriage after frozen embryo transfer (FET) cycles impact live birth rates and other reproductive and perinatal outcomes in subsequent FET cycles without preimplantation genetic testing for aneuploidy (PGT‐A). Methods This retrospective cohort study of women undergoing FET cycles (January 2016–December 2022) in our department who experienced early miscarriage diagnosed by transvaginal ultrasound examined the impact of medical versus surgical evacuation on subsequent live birth rates (LBR). Results Analysis of 1685 women revealed no significant differences in implantation, miscarriage, preterm birth, obstetric complications, or neonatal disease rates between groups. However, the surgical management group had lower positive pregnancy test, clinical pregnancy, and live birth rates, and higher cesarean rates. While adjustments for confounders eliminated the significance of differences in positive pregnancy tests and clinical pregnancies, lower live birth rates (aOR 0.80, 95% CI: 0.65–0.99) and higher cesarean rates (aOR 1.84, 95% CI: 1.19–2.84) persisted. The surgical group also showed significantly reduced endometrial thickness in subsequent cycles. Conclusion Subsequent FET cycles after surgical miscarriage evacuation show lower live birth rates and thinner endometrial lining than those following medical evacuation; surgical evacuation also correlates with increased cesarean section rates in non‐PGT‐A FET cycles.