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Autologous peripheral blood mononuclear cells intrauterine instillation to improve pregnancy outcomes after recurrent implantation failure: a systematic review and meta-analysis

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Recurrent implantation failure (RIF) is a common cause of disappointment and a big challenge after assisted reproduction technology treatments. The objective of this study was to evaluate the existing literature to explore whether peripheral blood mononuclear cells’ (PBMCs) instillation could improve pregnancy outcomes among patients with RIF.

Methods

We conducted a comprehensive search including PubMed, EMBASE, Cochrane library and various databases in China. Three randomized controlled trials (RCTs) and three non-randomized controlled trials (non-RCTs) were included. We included subgroup and sensitivity analyses using Stata 12.0.

Results

The results of the three RCTs showed that PBMC improved outcomes in all patients compared with placebo or no-treatment [clinical pregnancy rate (CPR): odds ratio (OR) 2.45, 95% confidence interval (CI) 1.53–3.91; implantation rate (IR): OR 2.46, 95% CI 1.48–4.09; live birth rate (LBR): OR 2.43, 95% CI 1.32–4.49]. However, the results of the three non-RCTs indicated that there were no statistically significant differences in the outcomes and that the heterogeneity was higher (I2 > 0%). Subgroup analysis further suggested that PBMCs treatment significantly increased the CPR, IR and LBR in the three or more implantation failure subgroups (CPR: OR 2.83, 95% CI 1.29–6.22; IR: OR 3.74, 95% CI 1.71–8.19; LBR: OR 3.03, 95% CI 1.15–7.98).

Conclusions

Among patients with three or more implantation failures, this treatment improved IR, LBR, and CPR compared to that in controls, due to the limited data available, PBMCs’ intrauterine instillation should only be used in the context of clinical trials.

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Acknowledgements

There was no funding received for the creation and completion of this work.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. First Clinical Medical College of LanZhou University, Lanzhou, 730000, GanSu, People’s Republic of China

    Yang Wu

  2. The Reproductive Medicine Special Hospital of the 1st Hospital of Lanzhou University, Lanzhou, 730000, GanSu, People’s Republic of China

    Lifei Li, Lin Liu, Xia Yang & Xuehong Zhang

  3. Key Laboratory for Reproductive Medicine and Embryo of Gansu, Lanzhou, 730000, GanSu, People’s Republic of China

    Lifei Li, Lin Liu, Xia Yang & Xuehong Zhang

  4. Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, 730000, Gansu, People’s Republic of China

    Peijing Yan

  5. Evidence-Based Medicine Center, School of Basic Medical Science, Lanzhou University, Lanzhou, 730000, Gansu, People’s Republic of China

    Kehu Yang

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  1. Yang Wu
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  2. Lifei Li
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  3. Lin Liu
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  4. Xia Yang
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Contributions

YW, LFL, and XHZ conceived and designed the study. YW, LFL, and XY analysed the data. YW and LL wrote the “Introduction and Discussion”. YW and PJY wrote the “Materials and methods” and “Results”. KHY and XHZ provided significant advice for the manuscript. YW and XY were primarily responsible for writing and modifying the draft.

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Correspondence to Xuehong Zhang.

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Wu, Y., Li, L., Liu, L. et al. Autologous peripheral blood mononuclear cells intrauterine instillation to improve pregnancy outcomes after recurrent implantation failure: a systematic review and meta-analysis. Arch Gynecol Obstet 300, 1445–1459 (2019). https://doi.org/10.1007/s00404-019-05275-w

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