Reproductive outcomes of women with recurrent pregnancy losses and repeated implantation failures are significantly improved with immunomodulatory treatment

• Published in: Journal of reproductive immunology 2021-11, Vol.148, p.103369-103369, Article 103369
• Main Authors: Sung, N., Khan, S.A., Yiu, M.E., Jubiz, G., Salazar, M.D., Skariah, A., Dambaeva, S., Kwak-Kim, J.
• Format: Article
• Language: English
• Subjects: Abortion, Habitual - drug therapy; Adolescent; Adult; Anti-Inflammatory Agents - therapeutic use; Anticoagulants - therapeutic use; Aspirin - therapeutic use; Female; Fertilization in Vitro; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Immunization; Immunoglobulins, Intravenous - therapeutic use; Immunotherapy; IVF; IVIG; Prednisone - therapeutic use; Pregnancy; Pregnancy Outcome; Recurrent pregnancy losses; Repeated implantation failure; Thrombophilia - drug therapy; Treatment Failure; Young Adult
• ISSN: 0165-0378; 1872-7603
• DOI: 10.1016/j.jri.2021.103369

•Immunomodulatory treatment improved the reproductive outcomes of IVF cycles in women with RPL and/or RIF of immune etiology.•The combination treatment with prednisone and IVIG showed a higher PR and LBR per cycle than prednisone only treatment.•The NK cell levels and cytotoxicities and Th1/Th2 cell ratios of all study populations at ET with immunomodulatory treatment were significantly decreased than those of pretreatment. This study investigated if immunomodulatory treatment improves the in-vitro fertilization (IVF) success rates of women with two or more recurrent pregnancy losses (RPL) and repeated implantation failures (RIF) with cellular immune abnormalities and thrombophilia. We performed a retrospective cohort study of 197 RPL patients who received immunomodulatory and anticoagulation treatment undergoing IVF cycles (fresh or frozen embryo transfer). Patients were divided into four groups; Group 1: women with RPL but without RIF, Group 2: women with RPL and RIF (≥3), Group 3: women with RPL after IVF cycles (>2) and without RIF, and Group 4: women with RPL after IVF cycles and RIF. Patients received immunomodulatory treatment with prednisone-only or prednisone and intravenous immunoglobulin G (IVIG) and anticoagulation treatment with low molecular weight heparin and low dose aspirin. IVF success rates of study groups were compared to those of the historical controls. The pregnancy rate of IVF cycles with immunomodulatory treatment was significantly increased in all patients (48.2 % vs. 33.0 %, P < 0.001), Group 1 (54.2 % vs. 30.5 %, P < 0.005) and Group 2 (33.3 % vs. 11.0 %, P < 0.005) as compared to historical controls. The live birth rates per ET cycle were significantly improved for all patients (1.8 % vs. 39.6 %, P < 0.001), and study groups compared to their historical controls (Group 1, 43.1 % vs. 0 %; Group 2, 33.3 % vs. 2.5 %; Group 3, 45.5 % vs. 2.3 %; and Group 4, 16.7 % vs. 1.2 %, P < 0.001, respectively). Immunomodulatory and anticoagulation treatment significantly improved the reproductive outcomes of IVF cycles in women with a history of RPL and/or RIF of immune etiologies.