The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis

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Abstract

A promising strategy for controlling repeated implantation failure (RIF) may be the use of hydroxychloroquine (HCQ). To the best of our knowledge, no systematic review has been conducted on the effects of hydroxychloroquine on pregnancy outcomes. A systematic research of the following electronic databases was conducted: Cochrane, EMBASE-Ovid, PubMed, Web of Science, and Scopus from inception to December 2021, using the following keywords [hydroxychloroquine] AND [infertility]. Fertilization and rate of live birth were significantly higher in the HCQ+ prednisone (PDN) group than in the PDN alone group. However, the abortion rate was not different between the two groups. The meta-analysis of two studies revealed no statistical significance between the PDN group and HCQ+PDN group regarding clinical pregnancy rate (OR=.14 [95%CI: 0.4–4.370]; heterogeneity; P=0.13; I2=54%; random effect model) and implantation rate (OR=1.99 [95%CI: 0.94–4.2]; heterogeneity; P=0.37; I2=0%; fixed-effect model). While HCQ may help improve fertilization and live birth rates, adding it to prednisone did not improve overall pregnancy outcomes. This systematic review should be used with caution due to the small size, study design, and difference in the studies' population

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Recurrent implantation failure: definition and management.

C. Coughlan, W. Ledger, Q. Wang … (2014)

Recurrent implantation failure refers to failure to achieve a clinical pregnancy after transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. The failure to implant may be a consequence of embryo or uterine factors. Thorough investigations should be carried out to ascertain whether there is any underlying cause of the condition. Ovarian function should be assessed by measurement of antral follicle count, FSH and anti-Mu¨llerian hormone. Increased sperm DNA fragmentation may be a contributory cause. Various uterine pathology including fibroids, endometrial polyps, congenital anomalies and intrauterine adhesions should be excluded by ultrasonography and hysteroscopy. Hydrosalpinges are a recognized cause of implantation failure and should be excluded by hysterosalpingogram; if necessary, laparoscopy should be performed to confirm or refute the diagnosis. Treatment offered should be evidence based, aimed at improving embryo quality or endometrial receptivity. Gamete donation or surrogacy may be necessary if there is no realistic chance of success with further IVF attempts. Copyright © 2013. Published by Elsevier Ltd.

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Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions

Asher Bashiri, Katherine Halper, Raoul Orvieto (2018)

Recurrent implantation failure (RIF) refers to cases in which women have had three failed in vitro fertilization (IVF) attempts with good quality embryos. The definition should also take advanced maternal age and embryo stage into consideration. The failure of embryo implantation can be a consequence of uterine, male, or embryo factors, or the specific type of IVF protocol. These cases should be investigated to determine the most likely etiologies of the condition, as this is a complex problem with several variables. There are multiple risk factors for recurrent implantation failure including advanced maternal age, smoking status of both parents, elevated body mass index, and stress levels. Immunological factors such as cytokine levels and presence of specific autoantibodies should be examined, as well as any infectious organisms in the uterus leading to chronic endometritis. Uterine pathologies such as polyps and myomas as well as congenital anatomical anomalies should be ruled out. Sperm analysis, pre-implantation genetic screening and endometrial receptivity should be considered and evaluated, and IVF protocols should be tailored to specific patients or patient populations. Treatment approaches should be directed toward individual patient cases. In addition, we suggest considering a new initial step in approach to patients with RIF, individualized planned activities to activate the brain's reward system in attempt to improve immunological balance in the body.

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Tumor Necrosis Factor-Alpha and Pregnancy: Focus on Biologics. An Updated and Comprehensive Review.

Jaume Alijotas-Reig, Enrique Esteve-Valverde, Raquel Ferrer-Oliveras … (2017)

Tumor necrosis factor-α (TNF-α) is a central regulator of inflammation, and TNF-α antagonists may be effective in treating inflammatory disorders in which TNF-α plays a major pathogenic role. TNF-α has also been associated with inflammatory mechanisms related to implantation, placentation, and pregnancy outcome. TNF-α is secreted by immune cells and works by binding to TNFR1 and TNFR2 cell receptors. TNF-α is also related to JAK/STAT pathways, which opens up hypothetical new targets for modifying. The accurate balance between Th1 cytokines, mainly TNF-α, Th17, and Th2, particularly IL-10 is essential to achieve good obstetric outcomes. TNF-α targeted therapy could be rational in treating women with obstetric complication related to overproduction of TNF-α, such as recurrent pregnancy loss, early and severe pre-eclampsia, and recurrent implantation failure syndrome, all "idiopathic" or related to aPL positivity. Along the same lines, Th1 cytokines, mainly TNF- α, play a leading pathogenic role in rheumatic and systemic autoimmune diseases occurring in women and, to a lesser extent, in men of reproductive age. These disorders have to be clinically silent before pregnancy can be recommended, which is usually only possible to achieve after intensive anti-inflammatory and immunosuppressive treatment, TNF-α blockers included. Physicians should be aware of the theoretic potential but low embryo-fetal toxicity risk of these drugs during pregnancy. From an updated review in May 2016, we can conclude that TNF-α blockers are useful in certain "refractory" cases of inflammatory disorders related to poor obstetric outcomes and infertility. Furthermore, TNF-α blockers can be safely used during the implantation period and pregnancy. Breastfeeding is also permitted with all TNF-α inhibitors. Since data on the actual mechanism of action of JAK-STAT in inflammatory obstetric disorders including embryo implantation are scarce, for the time being, therapeutic interventions in this setting should be discouraged. Finally, adverse effects on sperm quality, or causing embryo-fetal anomalies, in men treated with TNF inhibitors have not been described.

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Author and article information

Contributors

Masumeh Ghazanfarpour: https://orcid.org/0000-0003-4639-3711

Journal

Journal ID (nlm-ta): J Med Life

Journal ID (iso-abbrev): J Med Life

Journal ID (publisher-id): JMedLife

Title: Journal of Medicine and Life

Publisher: Carol Davila University Press (Romania )

ISSN (Print): 1844-122X

ISSN (Electronic): 1844-3117

Publication date (Print): February 2023

Volume: 16

Issue: 2

Pages: 189-194

Affiliations

[1 ]Department of Obstetrics and Gynecology, Faculty of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran

[2 ]Avicenna Infertility Clinic, Avicenna Research Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran

[3 ]Department of Community Health Nursing, Vali Asr Nursery, Shiraz, Iran

[4 ]Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

[5 ]Department of Educational Psychology, Islamic Azad University Mobarakeh Branch, Esfahan, Iran

[6 ]School of Public Health, Iran University of Medical Sciences, Tehran, Iran

[7 ]School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

[8 ]Social Security Organization, Isfahan University of Medical Sciences, Isfahan, Iran

[9 ]Department of Nursing, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

[10 ]Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran

Author notes

[* ] Corresponding Author: Masumeh Ghazanfarpour, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran. E-mail: Masumeh.ghazanfarpour@ 123456yahoo.com

Article

Publisher ID: JMedLife-16-189

DOI: 10.25122/jml-2022-0095

PMC ID: 10015562

PubMed ID: 36937474

SO-VID: 7cb71336-9752-4245-9ed7-61ed4505f77e

License:

This article is distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use and redistribution provided that the original author and source are credited.

The effects of hydroxychloroquine on pregnancy outcomes in infertile women: a systematic review and meta-analysis

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HLA-G and immune tolerance in pregnancy

Most cited references 16

Recurrent implantation failure: definition and management.

Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions

Tumor Necrosis Factor-Alpha and Pregnancy: Focus on Biologics. An Updated and Comprehensive Review.

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