Clinical outcome of intrauterine administration of peripheral mononuclear cells or human chorionic gonadotropin in unexplained implantation failure

Abstract

Problem: Intrauterine administration of autologous peripheral blood mononuclear cells (PBMCs) or human chorionic gonadotropin (hCG) has been proposed to facilitate embryo implantation, while its effect on clinical outcome of women with previous implantation failure (RIF) in frozen/thawed embryo transfer (FET) cycles is still unclear. Method of study: A total 523 patients having not experienced successful clinical pregnancy were enrolled in our study, including 207 repeat implantation failure (RIF) patients, and 316 patients with previous implantation failures but failed to meet the diagnostic criteria for RIF (non-RIF). Autologous PBMCs were cultured with hCG for 4 h in the hCG-activated PBMC-treated group (n = 73 in RIF patients, n = 112 in non-RIF patients), and then intrauterine administered 2 days before FET. In the hCGtreated group (n = 67 in RIF patients, n = 100 in non-RIF patients), recombinant hCG was administered 2 days before FET. The control group (n = 67 in RIF patients, n = 104 in non-RIF patients) underwent FET without intrauterine administration. Results:In RIF patients, the clinical pregnancy rate of the above three groups are 56.16%, 53.73%, and 43.28%, respectively (p = .276). The implantation rate and live birth rate showed no significant differences (p > .05). For non-RIF patients, higher clinical pregnancy rate was also seen in PBMC intrauterine group (57.15%) and hCG intrauterine group (58.00%) than controls (50.96%) but without statistical significance.There were no significant differences of implantation rate and live birth rate (p > .05). Conclusion:Intrauterine administration of hCG-activated PBMC and hCG did not improve clinical outcomes for both RIF and non-RIF patients before FET embryo transfer. K E Y W O R D Sautologous peripheral blood mononuclear cells, human chorionic gonadotropin, in vitro fertilization and embryo transfer, repeat implantation failure

Editorial for the special issue on “Clinical reproductive immunology in China”

“…For instance, intrauterine injection of hCG has been suggested to increase endometrial Tregs in patients with Treg‐reduced repeat implantation failure (RIF) with concomitant improvement in pregnancy outcome 10 . However, another study showed that neither Intrauterine administration of hCG nor hCG‐activated PBMC can improve clinical outcomes for both RIF patients before frozen embryo transfer (FET) embryo transfer 11 …”

“…10 However, another study showed that neither Intrauterine administration of hCG nor hCG-activated PBMC can improve clinical outcomes for both RIF patients before frozen embryo transfer (FET) embryo transfer. 11…”

Immune alterations in recurrent implantation failure

“…100 However, controversies exist on the beneficial effect of LIT treatment in patients with RIF and recurrent pregnancy loss. [101][102][103][104] Thus, the roles of LIT in improving clinical outcomes in RIF need more systematic investigations.…”

“…Mechanisms such as reduction in the Th1/Th2 ratios and their cytokines production, altered antipaternal cytotoxic antibodies, enhanced expression of progesterone‐induced blocking factor, anti‐idiotypic antibodies, and mixed lymphocyte reaction blocking antibodies are proposed to be involved in improving outcomes of LIT in RIF and recurrent pregnancy losses 100 . However, controversies exist on the beneficial effect of LIT treatment in patients with RIF and recurrent pregnancy loss 101–102,103–104 . Thus, the roles of LIT in improving clinical outcomes in RIF need more systematic investigations.…”

The role of macrophages in reproductive-related diseases

“…[ 38 ] 207 Human frozen/thawed embryo Cleavage and blastocyst HCG, 4 h No effect on implantation rate and live birth rate Mei et al. [ 150 ] RIF: recurrent implantation failure; PBMC: peripheral blood mononuclear cells; HCG: human chorionic gonadotrophin; CRH: corticotropin releasing hormone; HMG: human menopausal gonadotrophin. …”