Immunosuppressants in women with repeated implantation failure in assisted reproductive techniques: a systematic review and meta-analysis

Objective: To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization [IVF/ICSI] plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source: Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection: Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect: We computed odds ratios [ORs] for binary endpoints, with 95% confidence intervals [CIs]. Heterogeneity was assessed using I-2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis: Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 [46.37%]. Cyclosporine A improved implantation rate [OR 1.48; 95% CI 1.01-2.18] and clinical pregnancy [1.89, 95% CI 1.14-3.14]. Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth [OR 1.13, 95% CI 0.88-1.46] and miscarriage [OR 1.49, 95% CI 1.07-2.09]. Prednisolone showed no significant effect in patients undergoing IVF/ ICSI, clinical pregnancy [OR 1.34; 95% CI 0.76-2.36], or implantation rate [OR 1.36; 95% CI 0.76-2.42]. Conclusion: Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.