Introduction

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.

Aim

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.

Methods

Women were consecutively recruited from university departments with unexplained RIF.

Results

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.

中文翻译：

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原因不明的复发性植入失败：来自法国多中心研究的妊娠预测因素和治疗管理

介绍

复发性着床失败的定义是在体外受精/胞浆内单精子注射后至少移植了 3 次优质胚胎后没有怀孕。

目标

本研究的目的是描述不明原因 RIF 女性的多中心队列，分析与临床妊娠相关的因素并评估免疫调节疗法的疗效。

方法

女性被连续从大学部门招募，原因不明的 RIF。

结果

64 名女性平均年龄为 36 ± 3 岁。64 名妇女的临床妊娠率在未治疗和治疗周期中进行了比较，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。转移后的临床妊娠发现，56% 的妊娠使用 Intralipids 和 50% 的泼尼松，而未治疗的妊娠率为 5% (p < 0.001)。这 64 名妇女的 340 次胚胎移植导致 68 例临床妊娠和 18 例活产。接受治疗的胚胎移植与未接受治疗的胚胎移植相比，临床妊娠的频率明显更高（44 % 与 9 %；p < 0.001），优势比为 8.13（95 % CI 4.49–14.72，p < 0.0001）。考虑使用类固醇前后的总体转移以及仅使用类固醇的转移时，类固醇治疗转移的累积妊娠率高于未治疗转移。累积妊娠率与类固醇和脂质体处理的胚胎移植没有区别

结论

在这项针对不明原因 RIF 女性的多中心研究中，在胚胎移植前使用免疫调节治疗导致更高的临床妊娠率。需要在定义明确的 RIF 女性人群中进行随机、精心设计的研究，以确认我们的初步数据。