Egerup Pia, Nielsen Henriette Svarre, Andersen Anders Nyboe, Christiansen Ole Bjarne
The Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospitals, Hvidovre Hospital and Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark.
J Clin Med. 2022 Mar 29;11(7):1894. doi: 10.3390/jcm11071894.
Pregnancy loss after in vitro fertilization (IVF) is at least as common as after spontaneous conception. Recurrent pregnancy loss (RPL) may often have an immunological background, and it is therefore relevant to test immune-based interventions in these patients. The objective was to investigate the effect of immunotherapy with intravenous immunoglobulin (IvIg) and prednisone (PRS) as concomitant therapy to IVF in women with RPL after earlier IVF treatments. In a cohort study conducted at The Danish RPL Clinic, 41 women with three or more consecutive pregnancy losses after IVF underwent at least one further IVF cycle with concomitant immunotherapy from 2012 to 2017. The immunotherapy with IvIg and PRS was given before embryo transfer and repeatedly in the first trimester when pregnancy was achieved. Fourteen women (34.2%) achieved a live birth after the first embryo transfer with immunotherapy, and a total of 32/41 (78%) achieved a live birth after up to 4 embryo transfers. Baseline characteristics and the presence of autoantibodies were not significantly different among women achieving live birth or not. The observed 34% birth rate in women with RPL after IVF receiving immunotherapy appears higher than the expected 16-19% birth rate without immunotherapy and is similar to findings in a previous cohort from our clinic. Concomitant immunotherapy as described may be a promising intervention for women with RPL after IVF; however, the effect must be tested in a randomized controlled trial.
体外受精（IVF）后发生流产的情况至少与自然受孕后一样常见。复发性流产（RPL）往往有免疫方面的背景，因此对这些患者进行基于免疫的干预措施检测具有重要意义。目的是研究静脉注射免疫球蛋白（IvIg）和泼尼松（PRS）进行免疫治疗作为辅助疗法对既往IVF治疗后发生RPL的女性进行IVF的效果。在丹麦RPL诊所进行的一项队列研究中，41名IVF后连续发生三次或更多次流产的女性在2012年至2017年期间接受了至少一个周期的IVF并同时进行免疫治疗。IvIg和PRS免疫治疗在胚胎移植前给予，妊娠成功后在孕早期重复给药。14名女性（34.2%）在首次接受免疫治疗的胚胎移植后成功分娩，41名女性中共有32名（78%）在进行多达4次胚胎移植后成功分娩。成功分娩和未成功分娩的女性在基线特征和自身抗体的存在方面没有显著差异。接受免疫治疗的IVF后发生RPL的女性中观察到的34%的出生率似乎高于未进行免疫治疗时预期的16 - 19%的出生率，并且与我们诊所之前一个队列的研究结果相似。所述的辅助免疫治疗可能是IVF后发生RPL的女性的一种有前景的干预措施；然而，其效果必须在随机对照试验中进行检验。
