Peri‐implantation glucocorticoid administration for assisted reproductive technology cycles
Abstract
Background
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.
Objectives
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.
Search methods
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.
Selection criteria
All randomised controlled trials (RCTs) addressing the research question were included.
Data collection and analysis
Two reviewers independently assessed eligibility and quality of trials and extracted relevant data.
Main results
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.
Authors' conclusions
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.
PICOs
Plain language summary
Hormones for assisted reproduction
Glucocorticoids are a class of steroid hormones, with potent anti‐inflammatory and immunosuppressive properties. In order to improve embryo implantation in in‐vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles, the use of glucocorticoids has been advocated to improve the intra‐uterine environment. This review investigates whether the administration of glucocorticoids around the time of implantation improves clinical outcomes in women undergoing IVF or ICSI, compared to no glucocorticoid administration. The review of trials found no evidence that glucocorticoids helps to improve birth rates. However, there is some evidence of increased pregnancy rates among women undergoing IVF (rather than ICSI). More research is needed to elucidate the possible role of this therapy in well defined patient subgroups.
