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Abstract
BACKGROUND The use of peri-implantation glucocorticoids has been advocated to improve embryo implantation during assistive reproductive technology (ART) cycles such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). 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 activity, normalising the cytokine expression profile in the endometrium and by suppression of endometrial inflammation. OBJECTIVES To evaluate the effectiveness and safety of glucocorticoids versus no glucocorticoids administered around the time of anticipated implantation in women undergoing IVF or ICSI. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility (CGF) Group specialised register, CENTRAL (now also containing output from two trial registers and CINAHL), MEDLINE and Embase, on 20 December 2021, together with reference checking, contact with experts in the field and relevant conference proceedings to identify additional studies. This review is an update of the review first published in 2007 and last updated in 2012. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing the efficacy of supplementary systemic administration of glucocorticoids in the peri-implantation period with a placebo or no glucocorticoids in subfertile women undergoing IVF or ICSI were included. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were live birth rate and multiple pregnancy. MAIN RESULTS We included 16 RCTs (2232 couples analysed). We are uncertain whether glucocorticoids improved live birth rates (odds ratio (OR) 1.37, 95% confidence interval (CI) 0.69 to 2.71; 2 RCTs, n = 366; I2 = 7%; very low-certainty evidence). This suggests that if the chance of live birth following no glucocorticoids/placebo is assumed to be 9%, the chance following glucocorticoids would be between 6% and 21%. We are also uncertain whether there was a difference between peri-implantation glucocorticoids on multiple pregnancy rates per couple (OR 0.86, 95% CI 0.33 to 2.20; 4 RCTs, n = 504; I2 = 53%; very low-certainty evidence). The I2 of 53% may represent moderate statistical heterogeneity and results have to be interpreted with caution. With regard to pregnancy rates, we are uncertain whether there was a difference between ongoing pregnancy rates after glucocorticoids versus no glucocorticoids/placebo (OR 1.19, 95% CI 0.80 to 1.76; 3 RCTs, n = 476; I2 = 0%; very low-certainty evidence) and clinical pregnancy rates after glucocorticoids versus no glucocorticoids/placebo (OR 1.17, 95% CI 0.95 to 1.44; 13 RCTs, n = 1967; I2 = 0%; low-certainty evidence). This suggests that if the chance of clinical pregnancy following no glucocorticoids/placebo is assumed to be 25%, the chance following glucocorticoids would be between 24% and 32%. Furthermore, we are also uncertain whether peri-implantation glucocorticoids influenced miscarriage rates per couple (OR 1.09, 95% CI 0.63 to 1.87; 6 RCTs, n = 821; I2 = 0%; very low-certainty evidence), the incidence of ectopic pregnancies per couple (OR 2.28, 95% CI 0.33 to 15.62; 3 RCTs, n = 320; I2 = 0%; very low-certainty evidence) and ovarian hyperstimulation syndrome (OHSS) per couple (OR 1.07, 95% CI 0.60 to 1.90; 3 RCTs, n = 370; I2 = 0%; very low-certainty evidence) compared to no glucocorticoids/placebo. The evidence was very low to low certainty: the main limitations were serious risk of bias due to poor reporting of study methods, and serious imprecision. AUTHORS' CONCLUSIONS Overall, there was insufficient evidence that administration of peri-implantation glucocorticoids in IVF/ICSI cycles influenced clinical outcomes. These findings were limited to the routine use of glucocorticoids in subfertile women undergoing IVF or ICSI.
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Affiliation(s)
- Carolien M Boomsma
- Obstetrics and Gynaecology, Bravis Hospital, Bergen op Zoom, Netherlands
| | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, India
| | - Stephen D Keay
- Centre for Reproductive Medicine, UHCW NHS Trust, Coventry, UK
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Li T, Yuan Y, Liu H, Lu Q, Mu R. Glucocorticoids Improve the Pregnancy Rate and Outcome in Women With Unexplained Positive Autoantibodies: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:819406. [PMID: 35646975 PMCID: PMC9131042 DOI: 10.3389/fmed.2022.819406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/01/2022] [Indexed: 11/16/2022] Open
Abstract
The effect of glucocorticoid therapy on women with unexplained positive autoantibodies is under debate. This systemic review and meta-analysis were performed to evaluate whether glucocorticoid administration can improve the pregnancy outcome of this population. Relevant publications were searched from databases, and a total of seven prospective and retrospective cohort studies that investigated the effects of glucocorticoid administration on women with unexplained positive autoantibodies, were included. The outcomes of our systematic review and meta-analysis were measured in terms of risk ratios (RR) with 95% confidence intervals (CI) using fixed or random effect models. We found that glucocorticoid treatment improved the clinical pregnancy rate (RR 2.19, 95% CI 1.64–2.92) and live birth rate (RR 1.92, 95% CI 1.17–3.16), especially when glucocorticoid administration was started before pregnancy (clinical pregnancy rate: RR 2.30, 95% CI 1.58–3.34; live birth rate: RR 2.30, 95% CI 1.58–3.34). However, no effect of glucocorticoids on the miscarriage rate was found (RR 0.75, 95% CI 0.55–1.02) regardless of the time of drug administration. Our systematic review and meta-analysis support the rational use of glucocorticoids in women with unexplained positive autoantibodies.
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Affiliation(s)
- Ting Li
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Yilin Yuan
- Department of Psychiatry, Peking University Sixth Hospital, Beijing, China
| | - Huixin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People's Hospital, Beijing, China
| | - Qun Lu
- Reproductive Medical Center, Peking University People's Hospital, Beijing, China
| | - Rong Mu
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
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Zhou P, Yao Q, Zhao Q, Yang L, Yu Y, Xie J, Feng C, Zhou L, Jin M. IVF/ICSI outcomes of euthyroid infertile women with thyroid autoimmunity: does treatment with aspirin plus prednisone matter? BMC Pregnancy Childbirth 2022; 22:263. [PMID: 35351031 PMCID: PMC8966173 DOI: 10.1186/s12884-022-04532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
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). Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04532-2.
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Affiliation(s)
- Ping Zhou
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China
| | - Qiuping Yao
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China.,Jiaxing Maternity and Child Health Care Hospital, Zhejiang Province, 314051, Jiaxing, P.R. China
| | - Qiaohang Zhao
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China
| | - Lihua Yang
- Jinhua People's Hospital, 321000, Jinhua, Zhejiang Province, P.R. China
| | - Ya Yu
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China
| | - Jilai Xie
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China
| | - Chun Feng
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China
| | - Liming Zhou
- Ningbo Women and Children's Hospital, 315000, Ningbo, Zhejiang Province, P.R. China.
| | - Min Jin
- Second Affiliated Hospital, School of Medicine, Zhejiang University, 310052, Hangzhou, Zhejiang Province, P.R. China.
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Sheikhansari G, Pourmoghadam Z, Danaii S, Mehdizadeh A, Yousefi M. Etiology and management of recurrent implantation failure: A focus on intra-uterine PBMC-therapy for RIF. J Reprod Immunol 2020; 139:103121. [DOI: 10.1016/j.jri.2020.103121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/11/2023]
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Abstract
The field of assisted reproductive technology is shaped and changed constantly by advances in science and cutting-edge innovations. In a quest to maximise outcomes, add-on interventions are often adopted and utilised prematurely while the principles of evidence-based medicine seem to be less strictly adhered to. In this review we will attempt to summarise the latest evidence about some of the adjuvants.
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Affiliation(s)
- Luciano Nardo
- Reproductive Health Group, Daresbury Park, UK
- Manchester Metropolitan University, Manchester, UK
- CONTACT Luciano Nardo Reproductive Health Group, Daresbury Park, UK
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Siristatidis C, Dafopoulos K, Salamalekis G, Galazios G, Christoforidis N, Moustakarias T, Koutlaki N, Bouschanetzis C, Loutradis D, Drakakis P. Administration of low-molecular-weight heparin in patients with two or more unsuccessful IVF/ICSI cycles: a multicenter cohort study. Gynecol Endocrinol 2018; 34:747-751. [PMID: 29465258 DOI: 10.1080/09513590.2018.1442426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
To compare the effects of the administration of low-molecular-weight heparin (LMWH) in subfertile patients with two or more unsuccessful IVF/ICSI cycles. In this six-center two-arm retrospective cohort study, the study population (230 women) underwent a GnRH-antagonist protocol and was classified into two groups, according to the couse of LMWH or not. Groups were compared regarding the clinical and IVF/ICSI cycle characteristics and reproductive outcomes, whereas clinical pregnancy and miscarriage constituted the primary endpoints. Logistic regression analysis was performed to determine the potential predictors of clinical pregnancy, miscarriage and live birth rates using the Enter method. Baseline characteristics were comparable in the two groups. There was no statistically significant difference between the two study groups with regard neither to clinical pregnancy and miscarriage rates (33/133 vs. 20/97, p = .456 and 15/133 vs. 9/97, p = .624, respectively), nor to the secondary outcomes preset for this study (all p values >.05). Logistic regression revealed that age of the woman and ICSI and dose of gonadotrophins used were predictors of clinical pregnancy and live birth, respectively. In conclusion, there is no evidence to support the standard addition of LMWH in patients with two or more unsuccessful IVF/ICSI cycles.
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Affiliation(s)
- Charalampos Siristatidis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Konstantinos Dafopoulos
- b Assisted Reproduction Unit, Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine , University of Thessaly , Larissa , Greece
| | - George Salamalekis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - George Galazios
- c Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Medical School , Democritus University of Thrace , Alexandroupolis , Greece
| | | | | | - Nikoleta Koutlaki
- c Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Medical School , Democritus University of Thrace , Alexandroupolis , Greece
| | - Constantinos Bouschanetzis
- c Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Medical School , Democritus University of Thrace , Alexandroupolis , Greece
| | - Dimitrios Loutradis
- f First Department of Obstetrics and Gynecology , IVF Unit, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Petros Drakakis
- f First Department of Obstetrics and Gynecology , IVF Unit, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Yang XL, Chen F, Yang XY, Du GH, Xu Y. Efficacy of low-molecular-weight heparin on the outcomes of in vitro fertilization/intracytoplasmic sperm injection pregnancy in non-thrombophilic women: a meta-analysis. Acta Obstet Gynecol Scand 2018; 97:1061-1072. [PMID: 29700821 PMCID: PMC6100106 DOI: 10.1111/aogs.13359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/17/2018] [Indexed: 01/25/2023]
Abstract
Introduction The aim of our study was to evaluate the effect of low‐molecular‐weight heparin on pregnancy outcomes in women without thrombophilia during in vitro fertilization/intracytoplasmic sperm injection treatment. Material and methods We searched Pubmed, Web of Science, Embase, Cochrane and CNKI (from inception to 2 February 2018). Our study identified randomized controlled trials or quasi‐randomized controlled trials comparing low‐molecular‐weight heparin subcutaneous treatment with no treatment or only luteal support control. The outcomes included live birth rate, clinical pregnancy rate and miscarriage rate. Results Five trials, including 935 women receiving in vitro fertilization/intracytoplasmic sperm injection treatment, were included in meta‐analyses. There were 458 women receiving low‐molecular‐weight heparin and 477 in the control group. No significant differences for live birth rate, clinical pregnancy rate and miscarriage rate were found between the low‐molecular‐weight heparin and control groups. Of them, four trials reported live birth rate as an outcome and the risk ratio was 1.13 (95% confidence interval 0.88–1.43, p = 0.34). All five trials reported clinical pregnancy rate as an outcome, the risk ratio was 1.08 (95% confidence interval 0.87–1.32, p = 0.47). Three trials reported miscarriage rate and the risk ratio was 0.58 (95% confidence interval 0.30–1.10, p = 0.09). In women with two or more failed in vitro fertilization/intracytoplasmic sperm injection cycles, the risk ratio of live birth rate was 1.15 and the risk ratio of clinical pregnancy rate was 1.17. In women with three or more failed in vitro fertilization/intracytoplasmic sperm injection cycles, the risk ratios of live birth rate and clinical pregnancy rate were 1.36 and 1.35, respectively. Conclusions Our results suggested that low‐molecular‐weight heparin had no effect on pregnancy success rate in non‐thrombophilic women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. However, to justify the use of low‐molecular‐weight heparin in clinical practice, multicenter trials are still necessary.
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Affiliation(s)
- Xiu-Li Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Fei Chen
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Xiu-Ying Yang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines and Beijing Key Laboratory of Drug Target and Screening Research, Institute of Materia Medica of Peking Union Medical College, Beijing, China
| | - Guan-Hua Du
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines and Beijing Key Laboratory of Drug Target and Screening Research, Institute of Materia Medica of Peking Union Medical College, Beijing, China
| | - Yang Xu
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Siristatidis C, Dafopoulos K, El-Khayat W, Salamalekis G, Anifandis G, Vrantza T, Elsadek M, Papantoniou N. Administration of prednisolone and low molecular weight heparin in patients with repeated implantation failures: a cohort study. Gynecol Endocrinol 2018; 34:136-139. [PMID: 28949261 DOI: 10.1080/09513590.2017.1380182] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Conflicting results exist for low molecular weight heparin (LMWH) and prednisolone when tested as separate adjuncts for the improvement of the clinical outcomes in patients with repeated implantation failures (RIF) undergoing IVF/ICSI treatment. Through a cohort study, we evaluated the combined effect of both drugs on pregnancy parameters in 115 women with RIF. Clinical pregnancy rate was the primary end point while the sample size was calculated through the results of a pilot study. Clinical and IVF cycle characteristics were also compared between the groups. Baseline and cycle characteristics were comparable between groups. Biochemical and clinical pregnancy rates were similar in both groups [23/57 (40.4%) vs. 14/58 (24.1%), and 17/57 (29.8%) vs. 11/58 (19%), p = .063, and .175, respectively]. Similarly, miscarriage rates were comparable between the groups (35.7% vs. 34.8%), as well as live birth rates [15/57 (26.3%) vs. 9/58 (15.5%), p = .154]. In conclusion, the administration of LMWH with prednizolone in subfertile women with RIF seems not to improve clinical pregnancy rates, but a full-scaled RCT would definitely be more accurate.
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MESH Headings
- Adult
- Anticoagulants/adverse effects
- Anticoagulants/therapeutic use
- Cohort Studies
- Combined Modality Therapy/adverse effects
- Drug Therapy, Combination/adverse effects
- Egypt/epidemiology
- Family Characteristics
- Female
- Fertility Agents, Female/adverse effects
- Fertility Agents, Female/therapeutic use
- Fertilization in Vitro
- Glucocorticoids/adverse effects
- Glucocorticoids/therapeutic use
- Heparin, Low-Molecular-Weight/adverse effects
- Heparin, Low-Molecular-Weight/therapeutic use
- Hospitals, University
- Humans
- Infertility, Female/drug therapy
- Infertility, Female/therapy
- Infertility, Male
- Intention to Treat Analysis
- Male
- Outpatient Clinics, Hospital
- Ovulation Induction/adverse effects
- Prednisolone/adverse effects
- Prednisolone/therapeutic use
- Pregnancy
- Pregnancy Rate
- Retrospective Studies
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Affiliation(s)
- Charalampos Siristatidis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Konstantinos Dafopoulos
- b Assisted Reproduction Unit, Department of Obstetrics and Gynecology , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece
| | - Waleed El-Khayat
- c Department of Obstetrics and Gynecology , Faculty of Medicine, Cairo University , Egypt
- d Middle East Fertility Center , Giza , Egypt
| | - George Salamalekis
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - George Anifandis
- b Assisted Reproduction Unit, Department of Obstetrics and Gynecology , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece
| | - Tereza Vrantza
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
| | - Mostafa Elsadek
- c Department of Obstetrics and Gynecology , Faculty of Medicine, Cairo University , Egypt
- d Middle East Fertility Center , Giza , Egypt
| | - Nikolaos Papantoniou
- a Assisted Reproduction Unit, Third Department of Obstetrics and Gynecology , "Attikon Hospital", Medical School, National and Kapodistrian University of Athens , Athens , Greece
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Datta AK, Campbell S, Deval B, Nargund G. Add-ons in IVF programme - Hype or Hope? Facts Views Vis Obgyn 2015; 7:241-250. [PMID: 27729969 PMCID: PMC5058413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A series of new technologies and adjuvant therapies have been advocated in order to improve the success of IVF treatment. Dehydro-epiandrostenedione, growth hormones, Coenzyme Q 10, calcium ionosphores, immune therapy, heparin, low-dose aspirin, and vasodilators are among commonly prescribed pharmacological adjuvants. New technologies that are proposed to improve IVF outcomes include advanced sperm selection procedures, time- lapse embryo monitoring, preimplantation genetic screening, assisted hatching endometrial injury or embryo-glue. This review looked into current evidence to justify the use of these co-interventions and whether some of them can still be offered while awaiting more robust evidence to con rm or refute their role.
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Affiliation(s)
- A K Datta
- CREATE Fertility, 150 Cheapside, St Pauls, London EC2V 6ET, United Kingdom
| | - S Campbell
- CREATE Fertility, 150 Cheapside, St Pauls, London EC2V 6ET, United Kingdom
| | - B Deval
- CREATE Fertility, 150 Cheapside, St Pauls, London EC2V 6ET, United Kingdom
| | - G Nargund
- CREATE Fertility, 150 Cheapside, St Pauls, London EC2V 6ET, United Kingdom
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de Macedo JF, de Macedo GC, Campos LA, Baltatu OC. Successful Pregnancy Following Assisted Reproduction in Woman With Systemic Lupus Erythematosus and Hypertension: A Case Report. Medicine (Baltimore) 2015; 94:e1531. [PMID: 26376400 PMCID: PMC4635814 DOI: 10.1097/md.0000000000001531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with systemic lupus erythematosus have a poor prognosis of pregnancy, since it is associated with significant maternal and fetal morbidity, including spontaneous miscarriage, pre-eclampsia, intrauterine growth restriction, fetal death and pre-term delivery. We report a case with successful pregnancy in a patient with systemic lupus erythematosus and hypertension. A 39-year-old nulliparous woman presented with systemic lupus erythematosus with antinuclear and antiphospholipid antibodies, hypertension and recurrent pregnancy loss presented for assisted reproduction. The patient responded well to enoxaparin and prednisone during both assisted reproduction and prenatal treatment. This case report indicates that prescription of immunosuppressant and blood thinners can be safely recommended throughout the whole prenatal period in patients with systemic lupus erythematosus. Enoxaparin and prednisone may be prescribed concurrently during pregnancy.
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Affiliation(s)
- José Fernando de Macedo
- From Reproferty Reproductive Medicine Clinic, Sao Jose dos Campos, São Paulo, Brazil (JFdM, GCdM, LAC); Center of Innovation, Technology and Education (CITE), Camilo Castelo Branco University, Sao Jose dos Campos, Sao Paulo, Brazil (JFdM, LAC, OCB); and Faculty of Medicine, Estácio de Sá University, Rio de Janeiro, Brazil (GCDM)
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Dan S, Wei W, Yichao S, Hongbo C, Shenmin Y, Jiaxiong W, Hong L. Effect of Prednisolone Administration on Patients with Unexplained Recurrent Miscarriage and in Routine Intracytoplasmic Sperm Injection: A Meta-Analysis. Am J Reprod Immunol 2015; 74:89-97. [PMID: 25753479 DOI: 10.1111/aji.12373] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 02/06/2015] [Indexed: 01/23/2023] Open
Affiliation(s)
- Song Dan
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Wang Wei
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Shi Yichao
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Cheng Hongbo
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Yang Shenmin
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Wang Jiaxiong
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
| | - Li Hong
- Center for Reproduction and Genetics; Suzhou Municipal Hospital; Affiliated Hospital of Nanjing Medical University; Suzhou China
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Nardo LG, El-Toukhy T, Stewart J, Balen AH, Potdar N. British Fertility Society Policy and Practice Committee: Adjuvants in IVF: Evidence for good clinical practice. HUM FERTIL 2014; 18:2-15. [DOI: 10.3109/14647273.2015.985454] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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