Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis
Abstract The aim of the present systematic review and meta-analysis was to assess the effect of the different therapeutic options for repeated embryo implantation failure (RIF) on a subsequent IVF cycle outcome. Twenty-two RCTs and nineteen observational studies were included. Pooling of results sho...
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doaj-b159be05926d40b68ab2976175e85bfa2021-01-24T12:27:36ZengNature Publishing GroupScientific Reports2045-23222021-01-0111113110.1038/s41598-021-81439-6Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysisAndrea Busnelli0Edgardo Somigliana1Federico Cirillo2Annamaria Baggiani3Paolo Emanuele Levi-Setti4Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Clinical and Research Center-IRCCSDepartment of Clinical Sciences and Community Health, Università Degli Studi Di MilanoDepartment of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Clinical and Research Center-IRCCSDepartment of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Clinical and Research Center-IRCCSDepartment of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Clinical and Research Center-IRCCSAbstract The aim of the present systematic review and meta-analysis was to assess the effect of the different therapeutic options for repeated embryo implantation failure (RIF) on a subsequent IVF cycle outcome. Twenty-two RCTs and nineteen observational studies were included. Pooling of results showed a beneficial effect of intrauterine PBMC infusion on both CPR (RR 2.18; 95% CI 1.58–3.00; p < 0.00001; OR 2.03; 95% CI 1.22–3.36; p = 0.006) and LBR (RR 2.41; 95% CI 1.40–4.16; p = 0.002; OR 3.73; 95% CI 1.13–12.29; p = 0.03), of subcutaneous G-CSF administration on CPR (RR 2.29; 95% CI 1.58–3.31; p < 0.0001) and of intrauterine PRP infusion on CPR (RR 2.45; 95% CI 1.55–3.86; p = 0.0001). Observational studies also demonstrated a positive effect of IVIG and intrauterine hCG infusion on both CPR and LBR and of atosiban on CPR. Studies investigating intrauterine G-CSF infusion, LMWH, intravenous intralipid, hysteroscopy, blastocyst-stage ET, ZIFT, PGT-A and AH failed to observe an impact on IVF outcome. The quality of the evidence that emerged from RCTs focused on intrauterine PBMC infusion and subcutaneous G-CSF administration was moderate. For all other therapies/interventions it varied from low to very low. In conclusion, intrauterine PBMC infusion and subcutaneous G-CSF administration are the most promising therapeutic options for RIF. However, further well conducted RCTs are necessary before their introduction into clinical practice.https://doi.org/10.1038/s41598-021-81439-6 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Andrea Busnelli Edgardo Somigliana Federico Cirillo Annamaria Baggiani Paolo Emanuele Levi-Setti |
spellingShingle |
Andrea Busnelli Edgardo Somigliana Federico Cirillo Annamaria Baggiani Paolo Emanuele Levi-Setti Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis Scientific Reports |
author_facet |
Andrea Busnelli Edgardo Somigliana Federico Cirillo Annamaria Baggiani Paolo Emanuele Levi-Setti |
author_sort |
Andrea Busnelli |
title |
Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis |
title_short |
Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis |
title_full |
Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis |
title_fullStr |
Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis |
title_full_unstemmed |
Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis |
title_sort |
efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2021-01-01 |
description |
Abstract The aim of the present systematic review and meta-analysis was to assess the effect of the different therapeutic options for repeated embryo implantation failure (RIF) on a subsequent IVF cycle outcome. Twenty-two RCTs and nineteen observational studies were included. Pooling of results showed a beneficial effect of intrauterine PBMC infusion on both CPR (RR 2.18; 95% CI 1.58–3.00; p < 0.00001; OR 2.03; 95% CI 1.22–3.36; p = 0.006) and LBR (RR 2.41; 95% CI 1.40–4.16; p = 0.002; OR 3.73; 95% CI 1.13–12.29; p = 0.03), of subcutaneous G-CSF administration on CPR (RR 2.29; 95% CI 1.58–3.31; p < 0.0001) and of intrauterine PRP infusion on CPR (RR 2.45; 95% CI 1.55–3.86; p = 0.0001). Observational studies also demonstrated a positive effect of IVIG and intrauterine hCG infusion on both CPR and LBR and of atosiban on CPR. Studies investigating intrauterine G-CSF infusion, LMWH, intravenous intralipid, hysteroscopy, blastocyst-stage ET, ZIFT, PGT-A and AH failed to observe an impact on IVF outcome. The quality of the evidence that emerged from RCTs focused on intrauterine PBMC infusion and subcutaneous G-CSF administration was moderate. For all other therapies/interventions it varied from low to very low. In conclusion, intrauterine PBMC infusion and subcutaneous G-CSF administration are the most promising therapeutic options for RIF. However, further well conducted RCTs are necessary before their introduction into clinical practice. |
url |
https://doi.org/10.1038/s41598-021-81439-6 |
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