Does combined prednisolone and low molecular weight heparin have a role in unexplained implantation failure?

Fawzy, Muhammad; El-Refaeey, A.

doi:10.1007/s00404-013-3020-8

Cited by 34 publications

(22 citation statements)

References 13 publications

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“…A more recent study investigated a combined therapy of prednisolone 20 mg/day and LMWH 1 mg/kg/day among 295 women with one or more failed ICSI attempts (23). Treatment was started on the day of oocyte retrieval and continued until the eighth week of gestation.…”

Section: Glucocorticoidsmentioning

confidence: 99%

“…Add to this heparin's relative safety, low cost, and simple administration, and an attractive proposition emerges. We identified five randomized controlled studies investigating the possible positive effects from heparin on ART (23,(44)(45)(46)(47) (Table 2). Qublan et al investigated the effect of heparin on a population with three or more failed IVF attempts and at least one thrombophilia disorder.…”

Section: Heparinmentioning

confidence: 99%

See 1 more Smart Citation

Immune modulation treatments—where is the evidence?

Hviid

Macklon

2017

Fertility and Sterility

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While advances in assisted reproductive techniques have been substantial, failure of the apparently viable embryo to implant remains a source of distress and frustration to patients and specialists alike. The unique maternal immunological response to the embryo and the notion that defects in early placentation underlie the great complications of pregnancy have focused attention on the therapeutic potential of peri-implantation immunomodulation. On the face of it, the rationale for this approach is very attractive. However, as will be argued in this review, the clinical evidence base supporting the use of immunosuppressive treatments is weak and difficult to apply in practice and fails the needs of both doctors and their patients. This evidence gap is filled by justifications that are based largely on meeting patient expectations and commercial imperatives. However, this does not mean that immunomodulation treatments should be written off as ineffective. The literature in this field, while suffering the same challenges of heterogeneity, small studies, and publication bias as other areas of medicine, does hint at the way forward. Recurrent implantation failure and pregnancy loss are not diagnoses but clinical presentations that require appropriate phenotyping and etiological investigation. We are increasingly gaining the tools to make an "endometrial diagnosis," and these will allow us to design clinical studies of interventions that treat the underlying cause rather than the symptoms of implantation failure. The current evidence base does not support the clinical use of immunomodulation therapies in patients undergoing IVF. However, more discerning phenotyping may identify groups who could benefit.

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Section: Glucocorticoidsmentioning

confidence: 99%

Section: Heparinmentioning

confidence: 99%

Immune modulation treatments—where is the evidence?

Hviid

Macklon

2017

Fertility and Sterility

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“…In 2013, Fawzy and El-Refaeey [19] studied the effect of combining prednisolone (20 mg/day) with LMWH (1 mg/kg/day) daily starting from the day of oocyte pick-up in patients with recurrent implantation failure, and found a significant increase in both clinical pregnancy and implantation rates; the clinical pregnancy rate was 40.7% in the treatment group versus 27.5% in the control group, and the implantation rates were 23.9% and 14.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Does intrauterine injection of low-molecular-weight heparin improve the clinical pregnancy rate in intracytoplasmic sperm injection?

Kamel

El-Faissal

Aboulghar

et al. 2016

Clin Exp Reprod Med

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ObjectiveHeparin can modulate proteins, and influence processes involved in implantation and trophoblastic development. This study aimed to assess the improvement of clinical pregnancy and implantation rates after local intrauterine injection of low-molecular-weight heparin (LMWH) in patients undergoing intracytoplasmic sperm injection (ICSI).MethodsA randomised case/control design was followed in women scheduled for ICSI. The study arm was injected with intrauterine LMWH during mock embryo transfer immediately following the ovum pickup procedure, while the control arm was given an intrauterine injection with a similar volume of tissue culture media. Side effects, the clinical pregnancy rate, and the implantation rate were recorded.ResultsThe pregnancy rate was acceptable (33.9%) in the LMWH arm with no significant reported side effects, confirming the safety of the intervention. No statistically significant differences were found in the clinical pregnancy and implantation rates between both groups (p=0.182 and p=0.096, respectively). The odds ratio of being pregnant after intrauterine injection with LMWH compared to the control group was 0.572 (95% confidence interval [CI], 0.27−1.22), while the risk ratio was 0.717 (95% CI, 0.46−1.13; p=0.146). No statistical significance was found between the two groups in other factors affecting implantation, such as day of transfer (p=0.726), number of embryos transferred (p=0.362), or embryo quality.ConclusionIntrauterine injection of LMWH is a safe intervention, but the dose used in this study failed to improve the outcome of ICSI. Based on its safety, further research involving modification of the dosage and/or the timing of administration could result in improved ICSI success rates.

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“…Endometrial receptivity is the key element in assisted reproductive technology (ART) treatment, and a successful implantation of the embryo is a result of complex processes dependent upon many variables, most of which are still not adequately defined. 1,2 A substantial proportion of patients fail to become pregnant following ART treatment, and these failures seem to be concentrated across all age groups in specific subgroups of patients. The failures may be due to a limitation of current tools to select the most competent embryo or even more likely due to systemic factors, such as inflammation, that affect the maternal environment and negatively impact an embryo's ability to implant.…”

Section: Introductionmentioning

confidence: 99%

<p>Corticosteroids Prior to Embryo Transfer in Assisted Reproduction in Women with Crohn’s Disease and Ulcerative Colitis – A Nationwide Cohort Study</p>

Nørgård¹,

Larsen²,

Friedman³

et al. 2020

CLEP

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Purpose: Former studies have suggested that women with Crohn's disease (CD) and ulcerative colitis (UC) have a decreased chance of a live born child after assisted reproductive technology (ART) treatment. It is debated whether corticosteroids before ART may improve outcomes, either by decreasing inflammatory bowel disease-related inflammation or increasing endometrial receptivity. We examined the efficacy of corticosteroids before embryo transfer in women with CD and UC. Patients and Methods: Our cohort study is based on nationwide Danish health registries, comprising women with CD and UC receiving an embryo transfer (1 January 2006 through 2017). Exposed cohorts constituted women with CD and UC who had received corticosteroids within three months before embryo transfer, and the unexposed cohorts women with CD and UC who did not receive corticosteroids. Our primary outcome was live birth. We controlled for multiple covariates in the analyses. Results: We examined 2408 embryo transfers. In patients with CD, 114 embryo transfers were preceded by a corticosteroid prescription, and 964 were not. The corresponding numbers in UC were 122 and 1208, respectively. The adjusted odds ratio (aOR) for live birth in women with CD receiving corticosteroids before embryo transfer, relative to women with CD not receiving corticosteroids, was 0.89 (95% CI 0.49-1.63). The corresponding aOR in UC was 0.98 (95% CI 0.55-1.74). Conclusion: Corticosteroids prior to ART in women with CD and UC did not increase the chance of a live born child. The exact impact of corticosteroids prior to embryo transfer in patients with CD and UC still remains to be determined.

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Does combined prednisolone and low molecular weight heparin have a role in unexplained implantation failure?

Abstract: A combination of oral prednisolone and low molecular weight heparin may have a significant effect on pregnancy and implantation rates in prior unexplained, failed implantation.

Cited by 34 publications

References 13 publications

Immune modulation treatments—where is the evidence?

Immune modulation treatments—where is the evidence?

Does intrauterine injection of low-molecular-weight heparin improve the clinical pregnancy rate in intracytoplasmic sperm injection?

<p>Corticosteroids Prior to Embryo Transfer in Assisted Reproduction in Women with Crohn’s Disease and Ulcerative Colitis – A Nationwide Cohort Study</p>

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