atosiban and Infertility

Evidence for the efficacy of atosiban in improving pregnancy outcomes among patients undergoing assisted reproductive technology (ART) remains inconsistent.. The PubMed, EMBASE, and CNKI databases were searched using keywords such as 'atosiban', 'infertility', and 'ART'. Studies that explored the efficacy of atosiban in the field of ART for patients with embryo transfer (ET) were included if they evaluated pregnancy outcomes. Combing using subgroups and sensitivity analysis were conducted, and risk ratios (RRs), and 95% confidence intervals (CIs) were calculated.. Six studies were included. Atosiban treatment could improve pregnancy outcomes for all patients undergoing ET, especially for the subgroups of patients with repeated implantation failure (RIF) (implantation rate: RR = 1.806, 95% CI = 1.473-2.215; clinical pregnancy rate: RR = 1.725, 95% CI = 1.394-2.135; live birth rate: RR = 2.141, 95% CI = 1.494-3.068), as shown by the comparison with placebo or no-treatment groups. However, no statistical significance was detected in subgroups of patients undergoing their first or second ET cycle. In addition, no significant differences were observed in positive pregnancy tests, miscarriage rates, multiple pregnancy rates, or ectopic pregnancy rates.. Supplementation with atosiban has a positive effect on ART and embryo transfer procedure, especially for women undergoing their third or more ET cycle.

Topics: Abortion, Spontaneous; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Hormone Antagonists; Humans; Infertility; Live Birth; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Reproductive Techniques, Assisted; Tocolytic Agents; Vasotocin

Embryo transfer, the final stage of IVF/embryo transfer (IVF/ET) treatment, independently influences treatment outcome.Successful embryo implantation following embryo transfer, among other factors, is also dependant on uterine receptivity.Uterine contractile activity may adversely affect the implantation. Although increased contractions have been found in approximately 30% of patients undergoing embryo transfer, to date it has not been a subject to any diagnosis or therapy. Pharmacological tocolytics may be expected to improve pregnancy rates; however, targeting uterine adrenergic receptors, calcium channels or prostaglandin synthesis has since proven ineffective. The novel class of drugs which could be the most useful in this indication is oxytocin antagonists. In animal models, oxytocin significantly reduced embryo implantation rates, and this was reversed by an oxytocin antagonist. In humans, peptidyl oxytocin and mixed vasopressin V1A/oxytocin antagonists have been found to significantly reduce uterine contractions in egg donors undergoing mock embryo transfer. It has further been demonstrated that the vasopressin V1A/oxytocin receptor antagonist atosiban can improve pregnancy success in patients with recurrent IVF failures. This article reviews the uterine oxytocin/vasopressin V1A receptor systems and their potential influence on embryo implantation. It is suggested that the clinical application of oxytocin antagonists might improve results of IVF/ET treatment.

Topics: Animals; Antidiuretic Hormone Receptor Antagonists; Embryo Implantation; Female; Humans; Indoles; Infertility; Oligopeptides; Oxytocin; Pregnancy; Pyrrolidines; Receptors, Oxytocin; Reproductive Techniques, Assisted; Tocolytic Agents; Uterine Contraction; Vasopressins; Vasotocin

This prospective cohort study examined the effects of atosiban on uterine contraction, implantation rate (IR) and clinical pregnancy rate (CPR) in women undergoing IVF/embryo transfer. The study enrolled 71 women with repeated implantation failure (RIF; no pregnancies from an average of 4.8 previous embryo transfers with a mean of 12 top-quality embryos) undergoing IVF/embryo transfer using cryopreserved embryos. The total atosiban dose was 36.75 mg. The IR per transfer and CPR per cycle were 13.9% and 43.7%, respectively. Before atosiban, 14% of subjects had a high frequency of uterine contractions (≥ 16 in 4 min). The frequency of uterine contractions was reduced after atosiban. This reduction of uterine contractions in all cycles was significant overall (from 6.0 to 2.6/4 min; P<0.01), in cycles with ≥ 16 uterine contractions/4 min at baseline (from 18.8 to 5.1; P<0.01) and in cycles with <16 uterine contractions/4 min (from 3.9 to 2.2; P<0.01). IR and CPR improved in all subjects, irrespective of baseline uterine contraction frequency. This is the first prospective study showing that atosiban may benefit subjects with RIF undergoing IVF/embryo transfer with cryopreserved embryos. One potential mechanism is the reduction in uterine contractility, but others may also contribute. Many women undergoing IVF/embryo transfer do not achieve the outcome that they wish for. In fact, IVF/embryo transfer repeatedly fails for a subgroup of patients. There are limited options available to help these patients with repeat implantation failure (RIF) to become pregnant. This study looks at one potential new treatment option for women who experience RIF. A drug called atosiban is already being used to delay premature labour by inhibiting contractions of the uterus. In this study, atosiban was given at the time of embryo transfer to women undergoing IVF/embryo transfer. Atosiban reduced the number of uterine contractions in these patients and also increased the implantation and pregnancy rates. The pregnancy rate went from zero to 43.7%. The beneficial effects of atosiban were observed not only in patients who had a high frequency of uterine contractions at baseline but also in those who had a low frequency. These findings suggest that atosiban may have other benefits in addition to its effect on contractions of the uterus. More studies are required to find out exactly how atosiban works and to increase the knowledge of its use in patients with RIF undergoing IVF/embryo

Topics: Adolescent; Adult; Cohort Studies; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Hormone Antagonists; Humans; Infertility; Pregnancy; Pregnancy Rate; Prospective Studies; Reproductive Techniques, Assisted; Tocolytic Agents; Uterine Contraction; Vasotocin