Ana Clara Felix de Farias Santos, Fernanda Valeriano Zamora, Lubna Al-Sharif, Kush Sehgal, Deyvid Vieira Silva Cavalcante, Sarah Hasimyan Ferreira, Pedro Henrique Costa Matos da Silva
{"title":"Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis.","authors":"Ana Clara Felix de Farias Santos, Fernanda Valeriano Zamora, Lubna Al-Sharif, Kush Sehgal, Deyvid Vieira Silva Cavalcante, Sarah Hasimyan Ferreira, Pedro Henrique Costa Matos da Silva","doi":"10.61622/rbgo/2024rbgo70","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.</p><p><strong>Data source: </strong>Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.</p><p><strong>Study selection: </strong>Randomized clinical trials and observational studies with the outcomes of interest were included.</p><p><strong>Data collect: </strong>We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I<sup>2</sup> statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.</p><p><strong>Data synthesis: </strong>Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).</p><p><strong>Conclusion: </strong>Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.</p><p><strong>Prospero: </strong>CRD42023449655.</p>","PeriodicalId":74699,"journal":{"name":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460425/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.61622/rbgo/2024rbgo70","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.
Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.
Study selection: Randomized clinical trials and observational studies with the outcomes of interest were included.
Data collect: We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.
Data synthesis: Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).
Conclusion: Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.
目的比较反复植入失败的患者接受卵胞浆内单精子注射/体外受精（IVF/ICSI）加用泼尼松龙、强的松或环孢素A等免疫抑制剂与单独使用IVF/ICSI的结果：2023年9月在PubMed、Cochrane和Embase数据库中进行了系统检索：研究选择：纳入随机临床试验和具有相关结果的观察性研究：我们计算了二元终点的几率比（ORs）以及 95% 的置信区间（CIs）。使用 I2 统计量评估异质性。主要结果为活产、流产、着床率、临床妊娠和生化妊娠：数据综述：共纳入 7 项研究，2829 名患者。有 1312 例（46.37%）患者使用了免疫抑制治疗。环孢素 A 提高了植入率（OR 1.48；95% CI 1.01-2.18）和临床妊娠率（1.89，95% CI 1.14-3.14）。与非免疫抑制治疗相比，泼尼松龙和泼尼松没有改善活产率（OR 1.13，95% CI 0.88-1.46）和流产率（OR 1.49，95% CI 1.07-2.09）。泼尼松龙对接受体外受精/卵胞浆内单精子显微注射的患者、临床妊娠（OR 1.34；95% CI 0.76-2.36）或植入率（OR 1.36；95% CI 0.76-2.42）无明显影响：结论：环孢素A可提高植入率和临床妊娠率。结论：环孢素 A 可促进着床和临床妊娠率，但由于样本量有限，必须谨慎对待这些研究结果。我们的研究结果表明，泼尼松龙和强的松对反复植入失败的 IVF/ICSI 患者的临床结局没有任何有益影响：CRD42023449655。
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