Peri-implantation glucocorticoid administration for assisted reproductive technology cycles

Boomsma, Carolien M.; Kamath, Mohan S; Keay, Stephen D.; Macklon, Nick S.

doi:10.1002/14651858.cd005996.pub4

Cited by 15 publications

(12 citation statements)

References 81 publications

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“…These findings are consistent with a Cochrane meta-analysis that found no beneficial effect of peri-implantation corticosteroids in a nonselected IVF population, with regard to live birth, clinical pregnancy, and miscarriage rates. 22 Although the rates of overall pregnancy loss were similar between the 2 groups in this current trial, the risk of biochemical pregnancy loss appeared to be increased in the prednisone group. This is probably because prednisone could stimulate the secretion of hCG, 15 even though it did not increase the chance of implantation, leading to higher risk of pregnancy loss before clinical pregnancy.…”

Section: Discussionmentioning

confidence: 53%

“…However, these studies were also limited by methodological weaknesses including combined regimens of either aspirin or low-molecular-weight heparin (LMWH), small sample size, or nonrandomized or quasi-randomized design. A Cochrane review of 16 randomized trials showed no beneficial evidence of peri-implantation corticosteroids for clinical outcomes among the general IVF population but noted that this conclusion cannot be extrapolated to women with RIF …”

Section: Introductionmentioning

confidence: 99%

“…A Cochrane review of 16 randomized trials showed no beneficial evidence of peri-implantation corticosteroids for clinical outcomes among the general IVF population but noted that this conclusion cannot be extrapolated to women with RIF. 22 Despite widespread use of prednisone, no randomized clinical trial has been conducted to evaluate the effect of prednisone on live birth among women with RIF. The 2018 guideline on immunotherapy in IVF by the American Society for Reproductive Medicine appealed for trials to focus on women with implantation failure because it is the subpopulation for which potential benefits may exist.…”

mentioning

confidence: 99%

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Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization

Sun

Cui

et al. 2023

JAMA

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ImportanceImplantation failure remains a critical barrier to in vitro fertilization. Prednisone, as an immune-regulatory agent, is widely used to improve the probability of implantation and pregnancy, although the evidence for efficacy is inadequate.ObjectiveTo determine the efficacy of 10 mg of prednisone compared with placebo on live birth among women with recurrent implantation failure.Design, Setting, and ParticipantsA double-blind, placebo-controlled, randomized clinical trial conducted at 8 fertility centers in China. Eligible women who had a history of 2 or more unsuccessful embryo transfer cycles, were younger than 38 years when oocytes were retrieved, and were planning to undergo frozen-thawed embryo transfer with the availability of good-quality embryos were enrolled from November 2018 to August 2020 (final follow-up August 2021).InterventionsParticipants were randomized (1:1) to receive oral pills containing either 10 mg of prednisone (n = 357) or matching placebo (n = 358) once daily, from the day at which they started endometrial preparation for frozen-thawed embryo transfer through early pregnancy.Main Outcomes and MeasuresThe primary outcome was live birth, defined as the delivery of any number of neonates born at 28 or more weeks’ gestation with signs of life.ResultsAmong 715 women randomized (mean age, 32 years), 714 (99.9%) had data available on live birth outcomes and were included in the primary analysis. Live birth occurred among 37.8% of women (135 of 357) in the prednisone group vs 38.8% of women (139 of 358) in the placebo group (absolute difference, −1.0% [95% CI, −8.1% to 6.1%]; relative ratio [RR], 0.97 [95% CI, 0.81 to 1.17]; P = .78). The rates of biochemical pregnancy loss were 17.3% in the prednisone group and 9.9% in the placebo group (absolute difference, 7.5% [95% CI, 0.6% to 14.3%]; RR, 1.75 [95% CI, 1.03 to 2.99]; P = .04). Of those in the prednisone group, preterm delivery occurred among 11.8% and of those in the placebo group, 5.5% of pregnancies (absolute difference, 6.3% [95% CI, 0.2% to 12.4%]; RR, 2.14 [95% CI, 1.00 to 4.58]; P = .04). There were no statistically significant between-group differences in the rates of biochemical pregnancy, clinical pregnancy, implantation, neonatal complications, congenital anomalies, other adverse events, or mean birthweights.Conclusions and RelevanceAmong patients with recurrent implantation failure, treatment with prednisone did not improve live birth rate compared with placebo. Data suggested that the use of prednisone may increase the risk of preterm delivery and biochemical pregnancy loss. Our results challenge the value of prednisone use in clinical practice for the treatment of recurrent implantation failure.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR1800018783

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization

Sun

Cui

et al. 2023

JAMA

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“…On the other hand, there are studies in which prednisolone showed no benefit in the improvement of the outcomes in RIF patients [93]. The results of a recent systematic review about the effect of prednisolone administration in women undergoing IVF or intracytoplasmic sperm injection (ICSI) indicated almost no significant difference in live birth and clinical pregnancy rate of corticoid versus no corticoid or placebo group [94].…”

Section: Corticosteroidsmentioning

confidence: 99%

Recent Advances in Immunotherapeutic Approaches for Recurrent Reproductive Failure

Abdolmohammadi-Vahid¹,

Aghebati‐Maleki²,

Ahmadian-Heris³

et al. 2023

IVF Technologies and Infertility - Current Practices and New Perspectives

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Human reproduction is an insufficient process, disturbed by various factors, such as immunologic aberrations of mother. Immunologic abnormalities, including cellular and humoral immunity imbalance, cause dysregulated immune responses against embryo, fetus, and associated components and lack of maternal immunotolerance, which compromise the maintenance of pregnancy. Therefore, evaluation of immunologic parameters, including cellular and humoral immunity assessment (T and B lymphocyte, T helper subtypes, NK cells, cytokines, and autoantibodies), especially in women with a history of pregnancy loss or implantation failure, would help clinicians to manage the disorder and prevent next unfavorable pregnancy outcomes. Moreover, several immunomodulatory approaches have been introduced to modulate the abnormal immunologic responses in patients who experience reproduction failure, especially those diagnosed with immunologic basis. Anticoagulants, corticosteroids, intravenous immunoglobulin, immunosuppressive medications used in inhibition of graft rejection, such as calcineurin inhibitors, recombinant cytokines, and cell therapy approaches, are among these modalities. Here, we discuss the proposed mechanisms of immunologic abnormalities involved in the etiopathogenesis of reproduction disorders, besides the suggested immunologic tests and immunotherapeutic approaches which may be helpful in management of these disorders.

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“…Aim of corticosteroid therapy would be to reduce the aberrant populations of natural killer (NK) cells at the endometrium, to normalize cytokine expression, and/or to suppress endometrial inflammation [21]. A meta-analysis that included 16 RCTs with 2232 couples, showed insufficient evidences that peri-implantation glucocorticoid administration in IVF/ICSI cycles affects clinical outcomes [22]. A randomized study of 133 women who were positive for antinuclear antibodies (ANA) with a history of failed IVF implantation showed that combined treatment with prednisone 10 mg/day and aspirin 100 mg/day could improve the IVF outcome [23].…”

Section: Prednisonementioning

confidence: 99%

Adjuvant therapy in assisted fertilization procedures

Bila

Spremović-Radjenović

2022

Srp Arh Celok Lek

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Introduction. Despite continuous advances in assisted reproductive technologies (ART), their outcomes are limited. Before introducing adjuvant therapy to improve the in vitro fertilization (IVF) outcome, it is important to identify appropriate groups of patients, and avoid equal approach for everyone. Objective The objective of this paper was to review the available literature on the most commonly used adjuvant therapy aiming to improve the outcome of IVF. The guidelines of the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) were used, and the available literature was analyzed by searching the Medline-PubMed and Cochrane databases using appropriate keywords for each entity. Discussion. A review of the literature found no consistent evidences for the standard use of metformin in patients with polycystic ovarian syndrome (PCOSy), nor for use of dehydroepiandrosterone (DHEA), testosterone (T) and growth hormone (GH) in patients with premature ovarian failure or those with poor response to stimulation. The standard usage of prednisone and aspirin in the general population of patients in ART is also not recommended. Recently, the significance of the oxidative stress has been emphasized, which is why the use of antioxidants in the form of supplementation (Melatonin, vitamins C, A, E, Coenzyme Q) might be important in improving reproductive outcomes. Conclusion. The modern approach to the problem of infertility has become strictly individual. The application of adjuvant therapy in order to improve the outcome of ART procedures requires an analytical and critical approach in each individual case.

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Peri-implantation glucocorticoid administration for assisted reproductive technology cycles

Cited by 15 publications

References 81 publications

Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization

Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization

Recent Advances in Immunotherapeutic Approaches for Recurrent Reproductive Failure

Adjuvant therapy in assisted fertilization procedures

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