Dr. Mohammad Hedar, MRCOG

**Mifepristone for Term Induction — Could It Improve Cervical Ripening?**

Mifepristone is best known as a progesterone receptor antagonist, but its potential role in **term labour induction** is gaining renewed attention.

A 2026 systematic review and meta-analysis of randomized trials found that, compared with other induction strategies, mifepristone was associated with:

• Better cervical ripening and higher Bishop scores
• Shorter induction-to-delivery intervals
• Less need for prostaglandins and oxytocin
• Lower odds of caesarean delivery

Importantly, no clear increase in short-term maternal or neonatal adverse outcomes was identified — although safety reporting across the included trials was still limited.

So, is mifepristone ready to become a routine cervical-ripening agent at term?

The evidence is promising, but not yet definitive.

The infographic below summarizes the key numbers, clinical implications, and the questions that still need answering.

**Source:** Pellot IR et al. *Obstetrics & Gynecology*, 2026.
DOI: 10.1097/AOG.0000000000006450

7 hours ago | [YT] | 0

Dr. Mohammad Hedar, MRCOG

IVF First or IUI First in unexplained infertility?

A new randomized trial (FIIX, NEJM October 2026) adds an important message to counselling: starting with IVF led to a shorter time to live birth and a higher early cumulative live-birth rate than starting with stimulated IUI. In stage 1, live birth occurred in 31% with IUI-first versus 55% with IVF-first. However, when treatment continued over both stages, the overall cumulative live-birth rate became very similar: 70% vs 71%. Serious adverse events were more frequent with IVF, mainly related to oocyte retrieval or hyperstimulation.

What does this mean clinically?
If the goal is the fastest route to live birth, IVF-first appears more effective. But if the discussion includes cumulative outcomes, invasiveness, cost, and treatment burden, the picture becomes more balanced. In other words: IVF may win on time, but not necessarily on final cumulative live birth.

Swipe through the infographic for the key numbers and the practical counselling message.

Source: Prentice et al. In Vitro Fertilization or Intrauterine Insemination in Unexplained Infertility. NEJM. Published October 27, 2026.

1 day ago | [YT] | 0

Dr. Mohammad Hedar, MRCOG

**Chronic Endometritis & Doxycycline — Does Treating CD138-Positive Endometritis Improve Live Birth?**

Chronic endometritis has increasingly been investigated in women with recurrent miscarriage, and **CD138-positive stromal cells** are often used to support the diagnosis.

But does treating a positive biopsy with doxycycline actually improve pregnancy outcomes?

A new multicentre, double-blind, placebo-controlled RCT published in **Human Reproduction (August 2026)** provides an important answer.

Women with ≥2 consecutive first-trimester miscarriages who tested positive for CD138 were randomised to:

**Doxycycline 100 mg twice daily for 14 days**
vs
**Placebo**

The primary outcome was cumulative live birth or ongoing pregnancy ≥24 weeks.

**Result: no meaningful benefit.**

- Doxycycline: **52%**
- Placebo: **50%**
- Adjusted RR: **1.02**

There was also **no improvement in miscarriage rate, time to conception, or CD138 findings on repeat biopsy**.

This is important because previous observational studies suggested that “treating” chronic endometritis might improve reproductive outcomes.

This placebo-controlled trial challenges that assumption.

**Practical message:**

A positive CD138 biopsy alone should not automatically lead to doxycycline with the expectation of improving live birth in women with recurrent miscarriage.

And importantly, the study also showed substantial **inter-cycle variation in CD138 staining**, raising further questions about how reliably CD138 positivity defines clinically meaningful chronic endometritis.

This does **not** mean antibiotics never have a role when there is a genuine infectious indication.

It means:

**CD138 positivity ≠ proven antibiotic-responsive disease.**

And for recurrent miscarriage:

**Treating the biopsy did not improve the baby outcome that actually matters — live birth.**

2 days ago | [YT] | 0