Effects of Immunosuppressive Treatments on Pregnancy Outcomes in Infertile Women: A Systematic Review

Introduction: Despite recent significant advances in the field of vitro fertilization (IVF), the recurrent implantation failure (RIF) remains a serious challenge in the field of fertility. The suppression and regulation of the immune system by using immunomodulatory or immunosuppressive agents are one of the key ways to reduce RIF. We aimed to review the literature for the effect of immunosuppressive drugs on pregnancy outcomes in infertile women.

Materials and Methods: In this systematic review, two independent reviewers selected related articles of online databases (Scopus, EMBASE, Cochrane library, Web of Science, CINAHL, Medline, and CIVILICA), without time from inception restrictions up to July 2022. Studies were included if they were published in English and Persian and if they included original data on women exposure to immunosuppressive drugs.

Results: Fertilization rate, implantation rate and clinical pregnancy rate were significantly higher in prednisone +HCQ group than in prednisone group. However, abortion rate was not different between two groups. In the a retrospective cohort study, there was not difference between in treated group )hydroxychloroquine + cyclosporine (PDN + HCQ + CsA), prednisone + hydroxychloroquine (PDN + HCQ), prednisone (PDN) tcompared with untreated patients regarding rate of live birth, implantation biochemical and clinical pregnancy (p>0.05). Treatment with HCQ down-regulated Th17 related cytokines and function and up-regulated Treg related cytokines and function significantly (p<0.001). Hydroxychloroquine (400 mg/orally per day) treatment significantly decreased (p<0.0001) serum level of TNF-α and significantly increased serum level of IL-10 (p< 0.0001).

Conclusion: Based on the combined results, the immunoregulatory can be effective on fertilization rate and live birth rate, but it was not effective on reducing abortion rate.