Evidence for the effectiveness of immunologic therapies in women with subfertility and/or undergoing assisted reproduction

The evidence on the overall effectiveness and safety of immunomodulatory therapies in women undergoing assisted conception is largely uncertain, although some drugs may lead to improved outcomes in selected women.
Evidence for the effectiveness of immunologic therapies in women with subfertility and/or undergoing assisted reproduction

VOLUME 117, ISSUE 6, P1144-1159

Authors:

Pedro Melo, M.D., M.Sc., Teresa Thornton, M.B.Ch.B., Arri Coomarasamy, M.D., Ingrid Granne, D.Phil. 

Abstract:

Implantation is a critical step in the establishment of a successful pregnancy, depending on a complex immune-endocrine dialogue between the developing embryo and maternal endometrium. Research suggests that altered immunity in the maternal decidua results in implantation impairment and failure. Immunomodulatory drugs have, thus, been widely used in assisted conception to aid embryo implantation, despite an absence of consensus on their effectiveness and safety. We conducted a systematic review and meta-analysis of interventional studies investigating the use of immunomodulators in women undergoing assisted reproduction. Evidence was uncertain of an effect for most of the included interventions, owing to heterogeneous findings and a paucity of high-quality studies. For certain patient subgroups, however, the use of specific immunomodulatory therapies may offer some benefit. There is a need for further large randomized controlled trials to corroborate these findings.

Read the full text here.