The use of a TNF-alpha inhibitor and IVIG significantly improves IVF outcome in young infertile women with Th1/Th2 cytokine elevation.

The degree of preconception TNF/IL-10 elevation may correlate with an increased risk of IVF failure. Elevated TNF-α/IL-10 ratios can be corrected with therapy. It may be possible to improve IVF success rates by modulating high cytokine levels. Although our pilot database is small, the trends in the data are consistent and compelling. Larger studies are needed for confirmation.

In subfertile women with preconception Th1:Th2 and/or % CD56(+) cell elevation, IVF success rates are low without IVIG therapy but significantly improve with IVIG therapy. In patients with normal Th1:Th2 and normal CD56(+) cell levels, IVF success rates were not further improved with IVIG therapy. IVIG may be a useful treatment option for patients with previous IVF failure and preconception Th1:Th2 and/or NK elevation. Preconception immune testing may be a critical tool for determining which patients will benefit from IVIG therapy. Prospective controlled studies (preferably double-blind, stratified, and randomized) are needed for confirmation.

In subfertile women undergoing IVF, the oocyte DOR may help predict IVF success rates. This factor may offer an additional tool to help improve implantation rate, clinical pregnancy rate, live birth rate, and live birth rate per embryo transferred for an upcoming IVF cycle. Although many mechanisms may contribute to the oocyte DOR's negative effect on IVF success rates, its correlation with elevated preconception TNF-α:IL-10 ratio and correction with Humira suggests a strong immunologic component that may be treatable.

ObjectivesDespite the high burden of hepatitis C virus (HCV) infection in Egypt, screening of pregnant women is not yet universal, making national and global elimination unlikely. This study assessed the proportion of pregnant women who were screened for HCV infection at delivery, the prevalence and risk factors for HCV infection, the associated adverse neonatal outcomes, and the real‐life linkage to care of infected women and follow‐up of their infants’ HCV status and timing of testing.MethodsData were collected from medical records of a retrospective cohort of all pregnant women who were admitted to a university hospital in Cairo for delivery between January and June 2018 (n = 6734). HCV antibody‐ and RNA‐positive women and their infants were prospectively followed‐up by phone interviews till September 2019.Results2177 (32.3%) pregnant women were screened for HCV infection. 19 (0.9%) tested HCV antibody‐ and RNA‐positive. Being ≥ 30 years old (ORa 3.6, 95% CI: 1.4–9.2; P = 0.009), history of abortion (ORa 3.5, 95% CI: 1.2–10.3; P = 0.022) and blood transfusion (ORa 29.1, 95% CI: 9.6–88.4; P < 0.001) were independent risk factors for infection. Adverse neonatal outcomes did not vary significantly among HCV antibody‐positive and antibody‐negative women. Only 13 (68.4%) HCV antibody‐ and RNA‐positive women started treatment with direct‐acting antivirals (DAAs) post‐breastfeeding (two completed the treatment course and were cured). Four (21.1%) did not start treatment, and two (10.5%) were lost to follow‐up. All infants of the 13 HCV antibody‐ and RNA‐positive women who started DAA therapy tested HCV RNA‐negative within their first year of life.ConclusionExtending screening services to all pregnant women and better linkage to care are essential for the national elimination of HCV infection.