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Peri-implantation glucocorticoid administration for assisted reproductive technology cycles

Peri-implantation glucocorticoid administration for assisted reproductive technology cycles
Peri-implantation glucocorticoid administration for assisted reproductive technology cycles
Background: in order to improve embryo implantation for in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles the use of glucocorticoids has been advocated. It has been proposed that glucocorticoids may improve the intrauterine environment by acting as immunomodulators to reduce the uterine natural killer (NK) cell count and normalise the cytokine expression profile in the endometrium and by suppression of endometrial inflammation.

Objectives: to investigate whether the administration of glucocorticoids around the time of implantation improved clinical outcomes in subfertile women undergoing IVF or ICSI when compared to no glucocorticoid administration.

Search methods: the Cochrane Menstrual Disorders and Subfertility Group Trials Register (September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (September 2011), MEDLINE (1966 to September 2011), EMBASE (1976 to September 2011), CINAHL (1982 to September 2011) and Science Direct (1966 to September 2011) were searched. Reference lists of relevant articles and relevant conference proceedings were handsearched.

Selection criteria: all randomised controlled trials (RCTs) addressing the research question were included.

Data collection and analysis: two review authors independently assessed eligibility and quality of trials and extracted relevant data.

Main results: fourteen studies (involving 1879 couples) were included. Three studies reported live birth rate and these did not identify a significant difference after pooling the (preliminary) results (OR 1.21, 95% CI 0.67 to 2.19). With regard to pregnancy rates, there was also no evidence that glucocorticoids improved clinical outcome (13 RCTs; OR 1.16, 95% CI 0.94 to 1.44). However, a subgroup analysis of 650 women undergoing IVF (6 RCTs) revealed a significantly higher pregnancy rate for women using glucocorticoids (OR 1.50, 95% CI 1.05 to 2.13). There were no significant differences in adverse events, but these were poorly and inconsistently reported.

Authors' conclusions: overall, there was no clear evidence that administration of peri-implantation glucocorticoids in ART cycles significantly improved the clinical outcome. The use of glucocorticoids in a subgroup of women undergoing IVF (rather than ICSI) was associated with an improvement in pregnancy rates of borderline statistical significance and should be interpreted with care. These findings were limited to the routine use of glucocorticoids and cannot be extrapolated to women with autoantibodies, unexplained infertility or recurrent implantation failure. Further well designed randomised studies are required to elucidate the possible role of this therapy in well defined patient groups
Boomsma, Carolien M.
d5c20848-2432-47ce-b262-ad35407a64b9
Keay, Stephen D.
ae9b7a04-1307-4eba-a97d-6aa367ee1b79
Macklon, Nick S.
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e
Boomsma, Carolien M.
d5c20848-2432-47ce-b262-ad35407a64b9
Keay, Stephen D.
ae9b7a04-1307-4eba-a97d-6aa367ee1b79
Macklon, Nick S.
7db1f4fc-a9f6-431f-a1f2-297bb8c9fb7e

Boomsma, Carolien M., Keay, Stephen D. and Macklon, Nick S. (2012) Peri-implantation glucocorticoid administration for assisted reproductive technology cycles. Cochrane Database of Systematic Reviews. (doi:10.1002/14651858.CD005996.pub3). (PMID:22696356)

Record type: Article

Abstract

Background: in order to improve embryo implantation for in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles the use of glucocorticoids has been advocated. It has been proposed that glucocorticoids may improve the intrauterine environment by acting as immunomodulators to reduce the uterine natural killer (NK) cell count and normalise the cytokine expression profile in the endometrium and by suppression of endometrial inflammation.

Objectives: to investigate whether the administration of glucocorticoids around the time of implantation improved clinical outcomes in subfertile women undergoing IVF or ICSI when compared to no glucocorticoid administration.

Search methods: the Cochrane Menstrual Disorders and Subfertility Group Trials Register (September 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (September 2011), MEDLINE (1966 to September 2011), EMBASE (1976 to September 2011), CINAHL (1982 to September 2011) and Science Direct (1966 to September 2011) were searched. Reference lists of relevant articles and relevant conference proceedings were handsearched.

Selection criteria: all randomised controlled trials (RCTs) addressing the research question were included.

Data collection and analysis: two review authors independently assessed eligibility and quality of trials and extracted relevant data.

Main results: fourteen studies (involving 1879 couples) were included. Three studies reported live birth rate and these did not identify a significant difference after pooling the (preliminary) results (OR 1.21, 95% CI 0.67 to 2.19). With regard to pregnancy rates, there was also no evidence that glucocorticoids improved clinical outcome (13 RCTs; OR 1.16, 95% CI 0.94 to 1.44). However, a subgroup analysis of 650 women undergoing IVF (6 RCTs) revealed a significantly higher pregnancy rate for women using glucocorticoids (OR 1.50, 95% CI 1.05 to 2.13). There were no significant differences in adverse events, but these were poorly and inconsistently reported.

Authors' conclusions: overall, there was no clear evidence that administration of peri-implantation glucocorticoids in ART cycles significantly improved the clinical outcome. The use of glucocorticoids in a subgroup of women undergoing IVF (rather than ICSI) was associated with an improvement in pregnancy rates of borderline statistical significance and should be interpreted with care. These findings were limited to the routine use of glucocorticoids and cannot be extrapolated to women with autoantibodies, unexplained infertility or recurrent implantation failure. Further well designed randomised studies are required to elucidate the possible role of this therapy in well defined patient groups

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More information

e-pub ahead of print date: 13 June 2012
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 346456
URI: https://eprints.soton.ac.uk/id/eprint/346456
PURE UUID: db4ce342-e045-491d-8ec6-2b3e3feb8126

Catalogue record

Date deposited: 02 Jan 2013 13:21
Last modified: 01 Nov 2018 17:31

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