Intrauterine injection of human chorionic gonadotropin before embryo transfer can improve in vitro fertilization-embryo transfer outcomes: a meta-analysis of randomized controlled trials

Gao, Mingxia; Jiang, Xiangyan; Li, Bin; Li, LiFei; Duan, MengTao; Zhang, Xuehong; Tian, Jinhui; Qi, Keyan

doi:10.1016/j.fertnstert.2019.02.027

Cited by 38 publications

(32 citation statements)

References 28 publications

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“…The best IVF results were observed with the use of 500 IU hCG when compared with groups that used 700 and 1,000 IU of hCG. No significant difference was found in terms of outcomes between the first‐cycle and RIF subgroups 55 …”

Section: Discussionmentioning

confidence: 80%

Intrauterine perfusion immunotherapies in recurrent implantation failures: Systematic review

Cavalcante

Sarno

et al. 2020

American J Rep Immunol

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Studies have investigated the gestational outcomes of new immunological therapies in the treatment of patients with recurrent implantation failure (RIF) in assisted reproductive technology (ART). The objective of this article is to assess the current state of evidence available in the literature on intrauterine perfusion immunotherapies in women undergoing ART treatments. By considering the guidelines of Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA), the authors performed systematic review by searching the databases of PubMed/MEDLINE and Scopus using the following key words: “recurrent implantation failure,” “intrauterine infusion,” “Platelet‐Rich Plasma (PRP),” “Peripheral Blood Mononuclear Cells (PBMC),” “Granulocyte Colony‐Stimulating Factor (G‐CSF),” and “Human Chorionic Gonadotropin (hCG).” The authors analyzed the indications and the impact of new immunological therapies with intrauterine infusions on the pregnancy outcomes of patients undergoing ART. PRP, PBMC, G‐CSF, and hCG were the four most used immunological therapies with intrauterine infusion. These new therapies appear to improve the results of ART treatments in cases of RIF. However, the small number of studies does not allow definitive conclusions about the effectiveness of these therapies.

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Section: Discussionmentioning

confidence: 80%

Intrauterine perfusion immunotherapies in recurrent implantation failures: Systematic review

Cavalcante

Sarno

et al. 2020

American J Rep Immunol

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“…7). There was no evidence of publication bias in this regard (Egger's regression intercept: 12.16, 95%CI: -10.76, 35.08, P = 0.21). Sensitivity analysis showed that the estimates of the pooled SMD range from 0.67 (95% CI: 0.44, 0.89) to 1.12 (95% CI: 0.88, 1.36), suggesting that no one study is substantially in uencing the pooled estimate.…”

Section: Chemical Pregnancymentioning

confidence: 81%

“…Before our study, several systematic review and meta-analysis have studied the e cacy of different treatments (gonadotrophinreleasing hormone (GnRH) agonist [34], aspirin [14], human chorionic gonadotrophin (hCG) [35], combination of pentoxifylline and vitamin E [36]) in endometrial preparation for women undergoing assisted reproduction. However, evidence is insu cient to perform a particular protocol for endometrial preparation.…”

Section: Discussionmentioning

confidence: 99%

Effect of sildenafil citrate in women undergoing assisted reproduction: a meta-analysis based on randomized controlled trials

Rouholamin¹,

Sepidarkish²,

Razavi³

et al. 2020

Preprint

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Background to evaluate whether the sildenafil citrate in women undergoing assisted reproduction ameliorate the clinical outcomes. Methods We performed a comprehensive literature search for published randomized controlled trials (RCT) in Medline, Embase, Scopus, Web of Science and Cochrane Central Register of Controlled Trials from inception to 25 Jun 2020. Literature screening, selection of relevant studies, assessment risk of bias and data extraction was conducted independently by two reviewers. We combined study data using the random-effects model. Results Sixteen trials including 1,589 women (771 cases and 818 controls) were included in meta-analysis. Pooling results from five trials, which compared clinical pregnancy between sildenafil citrate and placebo, showed a significantly higher probability of clinical pregnancy in sildenafil citrate group (RR: 1.57, 95% CI: 1.05, 2.36, I2 = 0%). The probability of clinical pregnancy was significantly higher in women who received the combination of sildenafil citrate and clomiphene citrate compared with clomiphene citrate alone (RR: 1.31, 95% CI: 1.12, 1.53, I2 = 0%). Following the intervention, clinical pregnancy significantly increased in women who received the combination of estradiol valerate and sildenafil citrate compared to estradiol valerate (RR: 1.59, 95% CI: 1.05, 2.43, I2 = 0%). Following the intervention, endometrial thickness (ET) increased in women who received sildenafil citrate compared to women who received placebo (SMD: 1.32, 95% CI: 0.30, 2.34, I2 = 92.41%). The mean of ET was significantly higher in women who received the combination of sildenafil citrate and clomiphene citrate compared to women who received clomiphene citrate (SMD: 0.92, 95% CI: 0.49, 1.36). Conclusion Our systematic review and meta-analysis showed that luteal supplementation of sildenafil citrate (oral or vaginal), alone or adjuvant therapy can be used for improving the EM and clinical pregnancy rate in women undergoing assisted reproduction. However, given the methodological limitations the current evidence does not support its use in clinical practice yet.

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“…Further evidence from multicenter, randomized controlled trials are needed to confirm the potential therapeutical intervention of hCG. Several metaanalyses seem to show a positive effect in RIF patients (156,157).…”

Section: Infusion Of Hcg During Embryo Transfermentioning

confidence: 99%

Human Chorionic Gonadotrophin: New Pleiotropic Functions for an “Old” Hormone During Pregnancy

et al. 2020

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Human chorionic gonadotrophin (hCG) is the first specific molecule synthesized by the embryo. hCG RNA is transcribed as early as the eight-cell stage, and the blastocyst produces the protein before its implantation. hCG in the uterine microenvironment binds with its cognate receptor, luteinizing hormone/choriogonadotropin receptor (LHCGR), on the endometrial surface. This binding stimulates leukemia inhibitory factor (LIF) production and inhibits interleukin-6 (IL-6) production by epithelial cells of the endometrium. These effects ensure essential help in the preparation of the endometrium for initial embryo implantation. hCG also effects angiogenic and immunomodulatory actions as reported in many articles by our laboratories and other ones. By stimulating angiogenesis and vasculogenesis, hCG provides the placenta with an adequate maternal blood supply and optimal embryo nutrition during the invasion of the uterine endometrium. The immunomodulatory properties of hCG are numerous and important for programming maternal immune tolerance toward the embryo. The reported effects of hCG on uterine NK, Treg, and B cells, three major cell populations for the maintenance of pregnancy, demonstrate the role of this embryonic signal as a crucial immune regulator in the course of pregnancy. Human embryo rejection for hCG-related immunological reasons has been studied in different ways, and a sufficient dose of hCG seems to be necessary to maintain maternal tolerance. Different teams have studied the addition of hCG in patients suffering from recurrent miscarriages or implantation failures. hCG could also have a beneficial or a negative impact on autoimmune diseases during pregnancy. In this review, we will discuss the immunological impacts of hCG during pregnancy and if this hormone might be used therapeutically.

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Intrauterine injection of human chorionic gonadotropin before embryo transfer can improve in vitro fertilization-embryo transfer outcomes: a meta-analysis of randomized controlled trials

Cited by 38 publications

References 28 publications

Intrauterine perfusion immunotherapies in recurrent implantation failures: Systematic review

Intrauterine perfusion immunotherapies in recurrent implantation failures: Systematic review

Effect of sildenafil citrate in women undergoing assisted reproduction: a meta-analysis based on randomized controlled trials

Human Chorionic Gonadotrophin: New Pleiotropic Functions for an “Old” Hormone During Pregnancy

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