Short-term dexamethasone plus acetylsalicylic acid treatment during in vitro fertilization procedure

Yang

et al. 2021

Preprint

Background Thyroid autoimmunity (TAI) has been associated with adverse pregnancy outcomes. To settle with fertility problem, prescribing aspirin combined with prednisone (P+A) to women positive for antithyroid antibodies (ATA) is frequent in clinical practice, but the real effect remains controversial. Methods A multicenter, retrospective study was conducted in three reproductive centers from 2017 to 2020. We recruited 494 euthyroid infertile women positive for anti-thyroperoxidase and/or thyroglobulin antibodies (TPOAb and TgAb, respectively) with thyroid stimulating hormone (TSH) levels ranging 0.35-4.0mIU/L who were undergoing their first in vitro fertilization and embryo transfer (IVF-ET) cycle. Ultimately, 346 women were included of which 150 women were treated with prednisone (10mg/d) and aspirin (100mg/d), while the remaining 196 women were untreated (control group). Treatment started on the day of embryo transfer and continued until clinical pregnancy was determined. Results Clinical pregnancy rate (CPR) was 57.5% vs. 63.5% in the control and treated groups (P=0.414) for first fresh embryo transfer cycles and 57.8% vs. 61.8% for frozen-thawed embryo transfer cycles (P=0.606). Additionally, the live birth rate (LBR) at the fresh embryo transfer was 49.6% vs. 47.3% in the control and treated groups (P=0.762). Logistic regression revealed that P+A did not improve CPR or miscarriage rates (MR). Furthermore, we observed that low free triiodothyronine (FT3) was associated with high MR. Conclusions Utilizing an adjuvant treatment of P+A after the embryo transfer may be unnecessary in euthyroid women with TAI undergoing their first IVF-ET, regardless of embryo type (fresh or frozen).

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

IVF/ICSI outcomes of euthyroid infertile women with TAI: does treating with aspirin plus prednisone matter?

Yang

et al. 2021

Preprint

“…Such a medication approach was acknowledged as of value on pregnancy and implantation rates in contrast with untreated ATA + patients [34].The timing of medication in our study commenced on the day of embryo transfer and lasted for 2-6weeks, mainly focusing on fascinating the implantation micro-immune environment. In a prospective casecontrol study including 233 consecutive patients, dexamethasone(0.5 mg/d) and acetylsalicylic acid(100 mg/d) starting from the day of embryo transfer and continuing until the end of the 12th week of gestation increased the pregnancy rate and implantation rate when compared with the control group [42].But it was noteworthy that the inclusion of this prospective study was inherited and acquired thrombophilia, compound heterozygous polymorphisms, positive anti-nuclear and anti-thyroglobulin antibodies, the strong indication for steroid hormone and anticoagulant drug [42]. Coincidentally, its inclusion standard was exactly in line with the exclusion criteria in our study, which largely explained the con icting results.…”

Section: Discussionmentioning

confidence: 98%

IVF/ICSI Outcomes of Euthyroid Infertile Women With TAI: Aspirin Plus Prednisone Treatment, Does It Matter?

Yang

et al. 2021

Preprint

Objective Thyroid autoimmunity (TAI) per se has been demonstrated to be related to adverse pregnancy outcomes, including recurrent miscarriage and unexplained infertility. Although therapy of glucocorticoid to infertile remains controversial, aspirin combined with prednisone(P + A) are used frequently in antithyroid antibodies (ATA) positive infertile women in clinical practice. Methods A multicenter retrospective study was performed in the Second Affiliated Hospital of Zhejiang University School of Medicine, Ningbo Women and Children's Hospital and People's Hospital of Jinhua. We recruited 494 euthyroid infertile women positive for anti-thyroperoxidase antibody (TPOAb) and/or thyroglobulin antibody (TgAb) with thyroid stimulating hormone 0.35-4.0mIU/L, who undergoing first in vitro fertilization and embryo transfer (IVF-ET) cycle during the period of 2017 to 2020. 346 women were ultimately recruited, including 187 patients receiving fresh embryo transfer and 159 patients receiving frozen-thawed embryo transfer. Among them, infertile 150 women were treated with prednisone(10mg/d) and aspirin(100mg/d), while the other 196 infertile women were untreated as control group. The treatment commenced on the day of embryo transfer and continued until the clinical pregnancy was determined by ultrasonography around 30 days after embryo transfer. Results Clinical pregnancy rate (CPR) of the first fresh embryo transfer cycle was 57.5% vs. 63.5% in control vs. in treated group (P = 0.414) and CPR was 57.8% versus 61.8% in the two groups in the frozen-thawed embryo transfer cycle(P = 0.606). Additionally, the prevalence of delivering a live birth at the fresh embryo transfer was 49.6% in the non-treatment group and 47.3% in the P + A treated group(P = 0.762). Cumulative CPR was similar in the groups at the fresh embryo transfer (control vs treated group: 56.9% vs 61.0%, P = 0.534). By conducting logistic regression, combined treatment of P + A appeared to have no influence on CPR or miscarriage rates (MR) at the first embryo transfer. Furthermore, the low but within the reference level of free triiodothyronine (FT3) was seen as a poor predictor of spontaneous abortion at the fresh embryo transfer. Conclusions To conclude, with regard to euthyroid women with TAI undergoing the first IVF-ET cycle, adjuvant treatment of P + A after the embryo transfer may be unnecessary irrespective of the fresh or frozen-thawed embryo transfer.

“…In our study, treatment started on the day of embryo transfer and lasted for 2–6 weeks, mainly focusing on improving the micro-immune environment of the implantation site. In a prospective case-control study including 233 consecutive patients, dexamethasone (0.5 mg/d) and acetylsalicylic acid (100 mg/d) starting from the day of embryo transfer and until the end of the 12th week of gestation increased the pregnancy rate and implantation rate when compared with the control group [ 19 ]. The inclusion criteria of this prospective study included inherited and acquired thrombophilia, compound heterozygous polymorphisms, and positive anti-nuclear and anti-thyroglobulin antibodies, which were strong indications for steroid hormone and anticoagulant drugs [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a therapeutic alternative, corticosteroid hormones in combination with aspirin may potentially benefit blood perfusion to the ovaries and endometrium and decrease local inflammatory reactions to the transfer procedure, thereby inducing a more favorable microenvironment for the transferred embryo [ 14 , 15 ]. Furthermore, previous investigations have indicated that combined treatment of P + A is effective for women with various autoimmune diseases [ 16 – 19 ]. However, these trials were published long ago and do not demonstrate the efficacy of this approach in infertile women who are positive only for antithyroid antibodies.…”

Section: Introductionmentioning

confidence: 99%

IVF/ICSI outcomes of euthyroid infertile women with thyroid autoimmunity: does treatment with aspirin plus prednisone matter?

BMC Pregnancy Childbirth

Zhao

et al. 2022

Background Thyroid autoimmunity (TAI) has been demonstrated to be associated with adverse pregnancy including recurrent miscarriage, unexplained infertility, and implantation failure. To settle with the fertility problem, prescribing aspirin combined with prednisone (P + A) to women positive for anti-thyroid antibodies is frequent in clinical practice, but the underlying effect remains controversial. Methods A multicenter, retrospective study was conducted in three reproductive centers from 2017 to 2020. A total of 494 euthyroid infertile women were recruited who were positive for anti-thyroperoxidase and/or thyroglobulin antibodies (TPOAb and TgAb, respectively) with thyroid-stimulating hormone (TSH) levels ranging 0.35-4.0mIU/L and underwent their first in vitro fertilization and embryo transfer (IVF-ET) cycle. Ultimately, 346 women were included of which 150 women were treated with prednisone (10 mg/d) and aspirin (100 mg/d). The remaining 196 women were untreated (control group). Treatment started on the day of embryo transfer and continued until clinical pregnancy was determined. Results The clinical pregnancy rate was 57.5% vs. 63.5% in the control and treated groups (P = 0.414) for first fresh embryo transfer cycles and 57.8% vs. 61.8% for frozen-thawed embryo transfer cycles (P = 0.606). In addition, the live birth rate for the fresh embryo transfer was 49.6% vs. 47.3% in the control and treated groups (P = 0.762). Logistic regression revealed that aspirin plus prednisone did not improve the clinical pregnancy rate or miscarriage rate. Furthermore, it was observed that low free triiodothyronine (FT3) was associated with high miscarriage rates. Conclusions Utilizing an adjuvant treatment of P + A after the embryo transfer may not be necessary in euthyroid women with thyroid autoimmunity undergoing their first IVF-ET, regardless of the embryo type (fresh or frozen).