Background: Despite advancements in in-vitro fertilization (IVF), repeated implantation failure (RIF) remains a significant obstacle to fertility. Immunomodulation and immunosuppression are key strategies to address RIF. This study reviews the literature on the effects of immunosuppressive drugs on pregnancy outcomes in infertile women with RIF.
Materials and Methods: For this systematic review, two independent reviewers selected relevant articles from Scopus, EMBASE, the Cochrane Central Register of Controlled Trials, the International Registry Platform for ongoing trials, ClinicalTrials.gov, Web of Science, CINAHL, Medline, and Google Scholar. The search covered all available literature up to January 2023, without time restrictions.
Results: Combining prednisone and hydroxychloroquine (HCQ) significantly improves fertilization, implantation, and clinical pregnancy rates compared to prednisone alone, offering a promising immunomodulatory approach for women facing fertility challenges. HCQ modulates immune responses by reducing Th17-related cytokines and increasing T-reg-related cytokines, while also decreasing TNF-α and increasing IL-10 levels. Although abortion rates remain similar, adding cyclosporine to the regimen does not significantly improve outcomes. These findings suggest that prednisone with HCQ may be more effective than prednisone alone for specific patient populations.
Conclusion: Combining prednisone and HCQ significantly improves fertility outcomes by enhancing immune modulation. This combination offers a promising approach for women facing specific fertility challenges, although adding cyclosporine does not yield additional benefits in certain outcomes. Overall, HCQ's immunomodulatory effects support its potential in enhancing reproductive health.