Intravenous immunoglobulin for patients with unexplained recurrent implantation failure: a 6-year single center retrospective review of clinical outcomes

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2024年2月16日

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Einav Kadour Peero,
Shorooq Banjar,
Rabea Khoudja,
Shaonie Ton-leclerc,
Coralie Beauchamp,
Joanne Benoit,
Marc Beltempo,
Michael H. Dahan,
Phil Gold,
Isaac Jacques Kadoch,
Wael Jamal,
Carl Laskin,
Neal Mahutte,
Simon Phillips,
Camille Sylvestre,
Shauna Reinblatt,
Bruce D. Mazer,
William Buckett,
Genevieve Genest

摘要

The effectiveness of intravenous immunoglobulin (IVIg) for patients with unexplained recurrent implantation failure (uRIF) remains debated. We retrospectively analysed outcomes of uRIF patients treated with IVIg compared to a separate control uRIF cohort within our center (01/2014–12/2021). Primary outcomes included live birth, miscarriage, or transfer failure. We documented IVIg side effects and maternal/fetal outcomes. Logistic regression analysis was used to assess for association of IVIg exposure with outcomes and adjust for confounders. The study included 143 patients, with a 2:1 ratio of controls to patients receiving IVIg treatment. Patient characteristics were similar between groups. There was higher live birth rate (LBR) in patients receiving IVIg (32/49; 65.3%) compared to controls (32/94; 34%); p < 0.001). When stratifying patients into moderate and severe uRIF (respectively 3–4 and $\ge$ $\geq$ 5 previous good quality blastocyst transfer failures), only patients with severe uRIF benefited from IVIg (LBR (20/29 (69%) versus 5/25 (20%) for controls, p = 0.0004). In the logistic regression analysis, IVIg was associated with higher odds of live birth (OR 3.64; 95% CI 1.78–7.67; p = 0.0004). There were no serious adverse events with IVIg. IVIg can be considered in well selected patients with $\ge$ $\geq$ 5 previous unexplained, high quality blastocyst transfer failures. A randomized controlled trial is needed to confirm these findings.