Corticosteroids in patients with antiovarian antibodies undergoing in vitro fertilization:: a prospective pilot study
Corticosteroids in patients with antiovarian antibodies undergoing in vitro fertilization:: a prospective pilot study
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DOI：
10.1007/s00228-006-0169-0
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发表时间：
2006-09-01
影响因子：
2.9
通讯作者：
Bene, Marie-Christine
中科院分区：
文献类型：
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作者：
Forges, Thierry;Monnier-Barbarino, Patricia;Bene, Marie-Christine
目的：抗卵巢自身抗体（AOA）与生殖功能障碍有关，尤其是在体外受精（IVF）患者中。因此，使用皮质类固醇可能会提高IVF的成功率。然而，这些药物的治疗试验产生了相互矛盾的结果，特别是因为异质性的纳入标准。在既往IVF失败的女性中，我们选择了血清AOA检测阳性的患者，并分析了皮质类固醇在改善这些患者IVF结局方面的疗效。方法：选择100例经ELISA检测血清AOA且至少有2次IVF失败的患者。这些患者在治疗周期的第一天开始接受0.5 mg/kg泼尼松龙的进一步IVF周期。在怀孕的患者中，皮质类固醇给药至妊娠前三个月结束，然后逐渐停药。在取卵前后测定AOA。将皮质类固醇治疗周期的临床数据与每例患者先前IVF周期的数据进行比较。结果：未观察到皮质类固醇引起的不良反应。与之前的周期相比，在皮质类固醇治疗的尝试中，取卵后抗卵巢IgG显着降低。26次怀孕生下了30个健康的孩子。妊娠率、着床率和活产率分别为38.8%、17.8%和26.5%。结论：这项研究证实了皮质类固醇在提高既往IVF失败和血清AOA水平显著的患者亚组的成功率方面的有用性。
Objective: Antiovarian autoantibodies (AOA) have been associated with reproductive failure, especially in in vitro fertilization (IVF) patients. Thus, the success rate of IVF might be improved by the use of corticosteroids. However, therapeutic trials with these drugs have yielded conflicting results, particularly because of heterogeneous inclusion criteria. Among women with previous IVF failure, we selected those who presented with a positive serum AOA assay, and analysed the efficacy of corticosteroids in improving the IVF outcome in these patients. Methods: One hundred patients with serum AOA detected by ELISA and at least two previously failed IVF attempts were selected. These patients underwent a further IVF cycle with 0.5 mg/kg prednisolone, started on the first day of the treatment cycle. In patients who became pregnant, corticosteroids were administered until the end of the first trimester of pregnancy and then progressively discontinued. AOA were assessed before and after oocyte retrieval. Clinical data of the corticosteroid-treated cycle were compared with data from the preceding IVF cycle for each patient. Results: No adverse effects resulting from corticosteroids were observed. Post oocyte retrieval antiovarian IgG were significantly lower in corticosteroid-treated attempts when compared with the preceding cycles. Twenty-six pregnancies resulted in the birth of 30 healthy children. The pregnancy rate, implantation rate, and live birth rate were 38.8%, 17.8%, and 26.5% respectively in prednisolone-treated cycles. Conclusion: This study confirms the usefulness of corticosteroids in improving the success rate in a subset of patients with previous IVF failure and significant serum AOA levels.