The immunotherapy during in vitro fertilization and embryo transfer cycles in infertile patients with endometriosis. Glucocorticoid administration during transfer of frozen-thawed embryos: a prospective, randomized study. Short-term corticosteroid treatment does not improve implantation for embryos derived from subzonal insertion of sperm. The addition of a glucocorticoid to the protocol of programmed oocyte retrieval for in-vitro fertilization--a randomized study. Prednisolone supplementation to Clomid and/or gonadotrophin stimulation for in-vitro fertilization--a prospective randomized trial. The administration of glucocorticoids for the prevention of ovarian hyperstimulation syndrome in in vitro fertilization: a prospective randomized study. Successful glucocorticoid treatment for patients with abnormal autoimmunity on in vitro fertilization and embryo transfer. Does addition of low-dose aspirin and/or steroid as a standard treatment in nonselected intracytoplasmic sperm injection cycles improve in vitro fertilization success? A randomized, prospective, placebo-controlled study. Increasing clinical pregnancy rates after IVF/ET. Can immunosuppression help? Low dose prednisolone administration in routine ICSI patients does not improve pregnancy and implantation rates. Low-dose glucocorticoids after in vitro fertilization and embryo transfer have no significant effect on pregnancy rate.
To investigate if the immunotherapy with corticosteroids would improve the pregnancy rate in infertile patients with endometriosis who undergo in vitro fertilization and embryo transfer (IVF-ET).
                Forty-two infertile patients with endometriosis plus tubal factor and 87 pure tubal infertility patients who underwent IVF-ET in our unit were allocated randomly to the corticosteroid treatment group and the control group.
                The prevalence of autoantibodies (antinuclear antibody, lupus anticoagulant, anticardiolipin antibody, rheumatoid factor) was elevated significantly in patients with endometriosis plus tubal factor compared with pure tubal infertility patients (38.1% vs 2.3%). Twenty-one patients with endometriosis plus tubal factor underwent 54 cycles of IVF-ET, receiving corticosteroids. Forty-three patients with pure tubal factor underwent 81 cycles of IVF-ET, receiving corticosteroids. Twenty-one patients with endometriosis plus tubal factor who underwent 57 cycles of IVF-ET and 44 patients with pure tubal factor who underwent 84 cycles of IVF-ET served as controls, not receiving corticosteroids. In patients with endometriosis plus tubal factor, there was a significantly higher clinical pregnancy rate per cycle in the treatment group, with 42.6% (23/54) compared with 22.8% (13/57) in the control group but no differences between 2 groups in spontaneous abortion rate (21.7% vs 15.4%) and multiple pregnancy rate (17.4% vs 15.4%). In patients with pure tubal infertility, there were no significant differences between the treatment group and control group in clinical pregnancy rate (40.7% vs 34.5%), spontaneous abortion rate (12.1% vs 10.3%) or multiple pregnancy rate (18.2% vs 10.3%). In the endometriosis plus tubal infertility group with autoantibodies, the clinical pregnancy rate per cycle was significantly higher in the treatment group at 40.9% compared with 14.8% in the control group. In endometriosis plus tubal infertility group without autoantibodies, there was no significant difference between 2 groups with respect to the clinical pregnancy rate per cycle (43.8% vs 30.0%).
                This study suggests that immunotherapy with corticosteroids could improve the clinical pregnancy rate in endometriosis patients undergoing IVF-ET and may be more effective in patients with positive autoantibodies. To establish whether there is any improvement in pregnancy and implantation rates after administration of "low-dose," long-acting glucocorticoids during transfer of cryopreserved-thawed embryos.
                An IVF unit in a university hospital.
                Prospective, randomized study. Ninety-nine consecutive transfer cycles of frozen-thawed embryos to the uterine cavity of randomly chosen women diagnosed as having tubal factor infertility only. Fifty-two patients underwent transfer of frozen-thawed embryos and received 0.5 mg of dexamethasone; 47 women (control group) did not receive the drug during transfer.
                Normal ovulatory patients with tubal factor infertility.
                Oral dexamethasone administration before, during and after transfer of thawed embryos.
                Pregnancy and implantation rates.
                The pregnancy rate was 13.5% (7/52) in patients treated with the "low-dose" regimen of dexamethasone compared with 12.8% (6/47) in the control group. The implantation rate was similar.
                Our results demonstrated that the use of 0.5 mg dexamethasone for an immuno-suppressive effect, administered for a short period to patients diagnosed as having "pure" tubal factor infertility, did not improve the implantation or pregnancy rates. A total of 111 patients undergoing treatment for male factor infertility using SUZI participated in the trial for one treatment cycle only. They were allocated to have either corticosteroid treatment to induce immunosuppression or placebo. An elevated beta-hCG was found in 25% (9 of 36) of patients having an ET and receiving treatment. The corresponding figure for the control group was 33% (10 of 30). On ultrasound examination, fetal hearts were found in 22% (8 of 36) and 20% (6 of 30), respectively, of patients having an ET. chi 2 analysis showed no difference in the results. When the results were analyzed on a per oocyte basis there was no significant difference in the implantation rate. A group of 78 infertile women, diagnosed as having tubal factor infertility only, was enrolled in a prospective, randomized study conducted to determine whether the addition of different doses of glucocorticoids to the protocol of ovulation induction for in-vitro fertilization (IVF) would be beneficial. Oocyte numbers, percentage of fertilization, oestradiol, luteinizing hormone and follicle stimulating hormone serum concentrations, number of embryo transfers and pregnancy rate were evaluated. Compared to control cycles (group A; n = 24), the addition of 0.5 mg (group B; n = 27) of 1 mg dexamethasone (group C; n = 27), combined with the protocol of programmed oocyte retrieval for IVF patients in the study, demonstrated equivalent results. The mean numbers of oocytes retrieved were 10.8 +/- 3.9 in the control group, compared to 11.2 +/- 4.0 in group B and 10.5 +/- 3.6 in group C. The fertilization rates were 69 +/- 21, 66 +/- 18 and 70 +/- 15% respectively. The pregnancy rates were 20, 16 and 20.8% respectively. The addition of up to 1 mg dexamethasone daily to the protocol of ovulation induction for oocyte retrieval did not improve the overall IVF-embryo transfer outcome in patients with tubal factor infertility. In a prospective randomized trial, 73 patients received prednisolone, 7.5 mg daily, for one cycle in addition to Clomid and/or gonadotrophins, while another 73 patients were not given the corticosteroid. In-vitro fertilization (IVF) resulted in 16 versus six clinical pregnancies in the prednisolone and the non-prednisolone group, respectively (P less than 0.05). Oestrogen was significantly higher under prednisolone during the ovulatory phase, while LH was significantly lower. The adrenal androgen dehydroepiandrosterone sulphate was markedly depressed by prednisolone and testosterone was also markedly lower in the prednisolone group. A stress-related androgen excess might occur in some patients undergoing IVF with consequent cystic degeneration of some follicles as in polycystic ovarian disease. Prednisolone might counteract this detrimental effect by depressing adrenal and ovarian androgens. To determine if the administration of glucocorticoids reduced the rate of ovarian hyperstimulation syndrome (OHSS) in high-risk patients after ovarian stimulation for in vitro fertilization (IVF).
                Prospective randomized study.
                Thirty-one patients who were stimulated with human menopausal gonadotropin (hMG) after pituitary desensitization by gonadotropin-releasing hormone agonist and who developed greater than 20 follicles greater than 12 mm and/or had a serum estradiol (E2) level of greater than 10,000 pmol/L on the day of administration of human chorionic gonadotropin (hCG).
                Patients were randomly divided into two groups. Those who were randomized to receive glucocorticoids (group A) (n = 17) were administered intravenous hydrocortisone, 100 mg, immediately after ultrasound (US)-directed oocyte recovery. Prednisolone, 10 mg three times per day, was given for 5 days starting on the day of oocyte recovery followed by prednisolone 10 mg two times a day for 3 days and 10 mg/d for 2 days. Those in group B (n = 14) did not receive any glucocorticoid treatment. In both groups, luteal support was provided by intramuscular injections of gestone 100 mg/d.
                The two groups of patients were comparable in terms of age, duration of infertility, and total dose of hMG used. All had polycystic ovaries on US examination. On the day of hCG administration, the mean number of follicles in the two groups were 26.76 +/- 2.49 and 25.93 +/- 1.44 and the serum E2 concentration 13,404 +/- 710 and 13,915 +/- 901 pmol/L, respectively. There were no significant differences in the number of oocytes collected or in the fertilization, cleavage, and implantation rates in the two groups. The pregnancy rates per initiated cycle were 41.18% and 35.71%, respectively. Seven of the 17 patients (41.2%) who received glucocorticoids developed ovarian hyperstimulation syndrome compared with 6 of the 14 patients (42.9%) who did not receive glucocorticoids.
                Administrations of glucocorticoids to high risk patients did not reduce the rate of OHSS after ovarian stimulation for IVF. To analyze the effects of glucocorticoid treatment for patients with abnormal autoimmunity on IVF-ET outcomes, low-dose predonisolone or dexamethasone was administered in 51 IVF-ET cycles of 41 patients with positive antinuclear antibody (ANA), anti-DNA antibody, and/or lupus anticoagulant (LAC). Rates of clinical pregnancy and implantation in these patients were compared with those in 48 cycles without corticosteroid therapy. Autoantibody-negative patients were also treated with IVF-ET combined with (29 cycles) or without (57 cycles) glucocorticoid administration, and the pregnancy and implantation rates were investigated.
                Without glucocorticoid treatment, the pregnancy rate per cycle and implantation rate per embryo in antibody-positive patients were 10.4 and 3.8%, respectively. Significant increases in pregnancy (35.3%) and implantation (13.2%) rates were observed with corticosteroid treatment. In antibody-negative patients, the rates of pregnancy and implantation showed no significant differences with versus without the glucocorticoid administration.
                Our results indicate that because autoimmune abnormalities may be at least one cause of implantation failure following IVF-ET, the combined use of low-dose corticosteroid can be effective for autoantibody-positive women. To investigate the effects of short-term low-dose aspirin and/or steroid use on implantation and pregnancy rates in nonselected intracytoplasmic sperm injection (ICSI) cycles.
                Two-hundred patients undergoing ICSI for their first cycle were enrolled in this study. Participants were then randomized into four groups on the embryo transfer day. Aspirin (100 mg/day) in group A, prednisolone (10 mg/day) in group B, aspirin along with prednisolone in group C were given while placebo was administrated to group D.
                There were no statistically significant differences recorded in the demographic, ovulation induction cycle characteristics between groups. Mean transferred embryo number and mean top quality embryo number were similar among study groups. There were no statistical differences in implantation and pregnancy rates between study groups.
                Administration of low-dose aspirin and prednisolone alone or concomitant as a standard treatment have no positive effects on implantation and/or pregnancy rates. To evaluate the safety and efficacy of immunosuppression as an adjunct to improving the success of in vitro fertilization/embryo transfer (IVF-ET).
                A randomized, double-blind, placebo-controlled clinical trial.
                Seventy-five patients were randomized to receive either prednisone (39 patients, 51%) or placebo (36 patients, 49%). Patients in both groups had similar ages and numbers of preembryos transferred.
                Both the implantation and clinical pregnancy rates were higher in the prednisone group (16% vs. 11% and 43.5% vs. 32.3%, respectively). However, these differences did not achieve statistical significance. Evaluation of the ongoing pregnancy rate revealed little difference between the prednisone-treated patients (30.7%) and those receiving placebo (28.0%). There were no side effects reported by patients in either group. Glucocorticoids have been used in conjunction with zona dissection to improve pregnancy and implantation rates in IVF patients. The aim of this prospective randomized study was to evaluate the effect of low-dose prednisolone in addition to the standard protocol, on pregnancy and implantation rates in routine ICSI patients before and after embryo replacement.
                A total of 313 patients in 360 consecutive cycles (patients <39 years old and with three or less than three ICSI attempts) performed at our centre were randomly assigned by computer-generated list to receive either prednisolone (10 mg/day in two divided doses), starting on the first day of ovarian stimulation and continuing for 4 weeks (group A), or no treatment (group B).
                The mean age, number of previously failed IVF attempts, basal FSH levels and the mean rank of trials were comparable between groups A and B. The mean (+/- SD) number of metaphase II oocytes retrieved (11.9 +/- 5.5 versus 12.0 +/- 5.1), 2-pronuclei fertilization rate (67.2 versus 65.8%), the pregnancy and the implantation rates were not different between the study and control groups (49.0 and 23.6% versus 50.0 and 23.3% respectively).
                Low-dose prednisolone treatment in addition to the standard protocol before and after embryo replacement does not appear to have a significant effect on pregnancy or implantation rates. To determine the effect on pregnancy rate (PR) of low-dose glucocorticoid treatment in cycles without micromanipulation.
                Randomized, prospective, double-blinded, placebo-controlled trial.
                One university-based tertiary infertility center and two private infertility centers.
                All patients receiving standard stimulation IVF-ET or transfer of cryopreserved embryos at the participating facilities from January to September 1993 were asked to participate in this study. Patients having micromanipulation were excluded from this study.
                Participating patients were randomized to either 16 mg oral 6-alpha-methylprednisolone for four evenings starting the evening of retrieval or the evening before thawing cryopreserved embryos or to placebo administered in an identical fashion. Both groups were treated with 250 mg oral tetracycline four times per day starting with initiation of the study medication and continuing for 4 days. Cryopreservation and stimulation cycles were managed according to pre-established protocols for all patients. A clinical pregnancy was confirmed by an appropriately rising hCG titer and a gestational sac on ultrasound.
                A total of 206 stimulation patients and 61 cryopreservation patients were randomized and had an ET. Patient characteristics were similar between groups. The clinical pregnancy and implantation rates between placebo and glucocorticoid groups were 35.9% versus 40.8% and 12.8% versus 11.7% for stimulation cycles and 30.3% versus 25% and 9.9% versus 7.4% for cryopreservation cycles, respectively. None of these differences were statistically significant.
                Glucocorticoid plus antibiotic treatment at these doses for transfers of nonmicromanipulated embryos does not appear to have a significant effect on pregnancy or implantation rates.
Overall, there was no clear evidence that administration of peri-implantation glucocorticoids in ART cycles significantly improved the clinical outcome. The use of glucocorticoids in a subgroup of women undergoing IVF (rather than ICSI) was associated with an improvement in pregnancy rates of borderline statistical significance and should be interpreted with care. These findings were limited to the routine use of glucocorticoids and cannot be extrapolated to women with autoantibodies, 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.