Peri-implantation glucocorticoid administration for assisted reproductive technology cycles

Utrecht University, Utrecht, Utrecht, Netherlands
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2007; DOI: 10.1002/14651858.CD005996.pub2
Source: PubMed

ABSTRACT In order to improve embryo implantation in 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 intra-uterine environment by acting as immuno modulators to reduce the uterine NK cell count, normalise the cytokine expression profile in the endometrium and by suppression of endometrial inflammation.
To investigate whether the administration of glucocorticoids around the time of implantation improves clinical outcomes in subfertile women undergoing IVF or ICSI, compared to no glucocorticoid administration.
The Cochrane Menstrual Disorders and Subfertility Group's trials register (February 2006), the Cochrane Central Register of Controlled Trials (Cochrane Library Issue 2, 2006), MEDLINE (1966 to June 2006), EMBASE (1976 to June 2006), CINAHL (1982 to June 2006) and Science Direct (1966 to June 2006) were searched. Reference lists of relevant articles and relevant conference proceedings were also hand searched.
All randomised controlled trials (RCTs) addressing the research question were included.
Two reviewers independently assessed eligibility and quality of trials and extracted relevant data.
Thirteen studies (1759 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.
Overall, there is no clear evidence that administration of peri-implantation glucocorticoids in ART cycles significantly improves clinical outcome. The use of glucocorticoids in women undergoing IVF (rather than ICSI) was associated with an improvement in pregnancy rates of borderline statistical significance. These findings are limited to the routine use of glucocorticoids and cannot be extrapolated to women with auto-antibodies, 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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    • "Similarly, in the presence of ACA (anti-cardiolipin antibodies ), the use of heparin and aspirin showed no benefit (Stern et al., 2003). Attempts of administering steroids (Boomsma et al., 2007) or low-dose aspirin (Gelbaya et al., 2007) were also negative. "
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    ABSTRACT: BACKGROUND: The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) are the two largest societies in the world whose members comprise the major experts and professionals working in the field of reproductive medicine and embryology. These societies have never before had a joint scientific meeting. METHOD(S): A 3-day meeting was planned and took place in March of 2012. The goal was to present and debate key topics, as well as modes of practice in reproductive medicine and to discuss recent developments in the field. RESULT(S): Presentations by members of ASRM and ESHRE were of three types: 'state of the art' lectures, 'back-to-back' presentations of two points of view and debates. CONCLUSION(S): For the first time, ASRM and ESHRE held a joint meeting where a special emphasis was given to presentations on the hottest topics in the field. Although different opinions and approaches sometimes exist on the two sides of the Atlantic, an appreciation and acceptance of these differences was evident, and there was more commonality than divergence of opinion.
    Fertility and sterility 10/2012; 98(6). DOI:10.1016/j.fertnstert.2012.07.1164 · 4.59 Impact Factor
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    • "intravaginal application of exogenous cortisol from Days 15 to 18 post insemination increased the pregnancy rate and reduced TNFαstimulated PGFM levels, whereas the inhibition of local cortisol biosynthesis by intravaginal application of metyrapone decreased the pregnancy rate in heifers. These results agree with those of Boomsma et al. (2007), who reported an increase in pregnancy rate as a result of GC administration [51]. The above results suggest that cortisol plays an important role in maintaining CL function by directly inhibiting uterine PGF 2α secretion to support embryo implantation and early embryonic development. "
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    3rd Annual COST GEMINI Meeting; 01/2010
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    • "For example, in healthy volunteers, daily oral administration of prednisolone halved the total population of lymphocytes within 7 h of the first glucocorticoid treatment, and reduced the proportion of peripheral NK cells (from 16.5 to 9.5% of lymphocytes) over 3 days (Pountain et al., 1993). In light of their immunosuppressant actions, it has been suggested that glucocorticoids might assist in preventing immune rejection of the implanting embryo (Boomsma et al., 2007). Recent studies have implicated uterine NK cells in recurrent miscarriage. "
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