Sorbonne Université, APHP, Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, Faculté de Médecine Sorbonne Université, France.
Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), F-75012, Paris, France.
J Reprod Immunol. 2021 Jun;145:103313. doi: 10.1016/j.jri.2021.103313. Epub 2021 Mar 22.
Recurrent implantation failure is defined as the absence of pregnancy after at least three transfers of good-quality embryos after in vitro fecundation/intracytoplasic sperm injection.
The aim of this study was to describe a multicentre cohort of women with unexplained RIF, to analyse the factors associated with clinical pregnancy and to evaluate the immunomodulatory therapies efficacy.
Women were consecutively recruited from university departments with unexplained RIF.
Sixty-four women were enrolled with mean age 36 ± 3 years. The rates of clinical pregnancy in 64 women were compared in untreated and treated cycles and according to therapies used during the last prospectively followed embryo transfer. A clinical pregnancy after the transfer was noted in 56 % pregnancies on intralipids and in 50 % on prednisone, versus 5 % in untreated ones (p < 0.001). The 340 embryo transfers of these 64 women resulted in 68 clinical pregnancies and 18 live births. Clinical pregnancies were significantly more frequent in treated versus untreated embryo transfers (44 % vs 9 %; p < 0.001) with odds ratio at 8.13 (95 % CI 4.49-14.72, p < 0.0001). Cumulative pregnancy rates were higher for steroid-treated transfers than for untreated transfers when considering overall transfers before and after using steroids and also only those under steroids. Cumulative pregnancy rates were not different from steroid- and intralipid-treated embryo transfers CONCLUSIONS: In this multicentre study of women with unexplained RIF, use of immunomodulatory treatments before embryo transfer resulted in higher clinical pregnancy. Randomised, well-designed studies in well-defined population of RIF women are necessary to confirm our preliminary data.
反复着床失败是指体外受精/胞浆内单精子注射后至少进行了三次优质胚胎移植仍未能妊娠。
本研究旨在描述一组不明原因反复着床失败患者的多中心队列，分析与临床妊娠相关的因素，并评估免疫调节治疗的疗效。
从有不明原因反复着床失败的大学系部分批招募患者。
共纳入 64 例患者，平均年龄 36±3 岁。比较了 64 例患者未治疗和治疗周期的临床妊娠率，并根据最后一次前瞻性胚胎移植期间使用的治疗方法进行了比较。在脂多糖组和地塞米松组中，转移后临床妊娠率分别为 56%和 50%，而未治疗组为 5%（p<0.001）。这 64 例患者的 340 个胚胎转移导致 68 例临床妊娠和 18 例活产。与未治疗胚胎转移相比，治疗胚胎转移的临床妊娠率显著更高（44% vs 9%；p<0.001），优势比为 8.13（95%置信区间 4.49-14.72，p<0.0001）。在考虑使用类固醇前后以及仅在使用类固醇期间的所有胚胎转移和总体转移中，类固醇治疗的胚胎转移累积妊娠率均高于未治疗的胚胎转移。类固醇和脂多糖治疗的胚胎转移的累积妊娠率无差异。
在这项针对不明原因反复着床失败患者的多中心研究中，胚胎移植前使用免疫调节治疗可提高临床妊娠率。需要在明确定义的反复着床失败女性人群中进行随机、精心设计的研究，以证实我们的初步数据。
