Carolien M Boomsma1, Nick S Macklon. 1. Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands. c.m.boomsma@umcutrecht.nl
Abstract
PURPOSE OF REVIEW: Failure of the embryo to implant remains the major limiting step in assisted reproductive techniques success rates. The existing evidence supports a possible role of glucocorticoids in improving the intrauterine environment and therefore embryo implantation. The present study aims to summarize the available evidence and make recommendations about the use of glucocorticoids. RECENT FINDINGS: A recent meta-analysis on glucocorticoids to improve embryo implantation showed no beneficial effect in the routine IVF/intracytoplasmic sperm injection population, although a subgroup analysis of women undergoing IVF did show a borderline improvement in pregnancy rates. Studies on women with autoantibodies or treatment cycles in which assisted hatching is performed have also indicated a benefit from glucocorticoid cotreatment. No significant improvement in pregnancy rates, however, has been demonstrated in women with recurrent implantation failure in whom assisted hatching is performed in combination with glucocorticoids. Conflicting results have been reported on the use of glucocorticoids to improve the ovarian response. SUMMARY: Although evidence to support the empirical use of glucocorticoids to improve implantation is insufficient, these may be beneficial in specific patient groups. More studies are required to confirm the efficacy and safety of adjuvant glucocorticoid therapy, and they should only be empirically used in the context of randomized controlled trials.
PURPOSE OF REVIEW: Failure of the embryo to implant remains the major limiting step in assisted reproductive techniques success rates. The existing evidence supports a possible role of glucocorticoids in improving the intrauterine environment and therefore embryo implantation. The present study aims to summarize the available evidence and make recommendations about the use of glucocorticoids. RECENT FINDINGS: A recent meta-analysis on glucocorticoids to improve embryo implantation showed no beneficial effect in the routine IVF/intracytoplasmic sperm injection population, although a subgroup analysis of women undergoing IVF did show a borderline improvement in pregnancy rates. Studies on women with autoantibodies or treatment cycles in which assisted hatching is performed have also indicated a benefit from glucocorticoid cotreatment. No significant improvement in pregnancy rates, however, has been demonstrated in women with recurrent implantation failure in whom assisted hatching is performed in combination with glucocorticoids. Conflicting results have been reported on the use of glucocorticoids to improve the ovarian response. SUMMARY: Although evidence to support the empirical use of glucocorticoids to improve implantation is insufficient, these may be beneficial in specific patient groups. More studies are required to confirm the efficacy and safety of adjuvant glucocorticoid therapy, and they should only be empirically used in the context of randomized controlled trials.