Please wait a minute...
Clinical and Experimental Obstetrics & Gynecology  2017, Vol. 44 Issue (2): 230-235    DOI: 10.12891/ceog3375.2017
Original Research Previous articles | Next articles
Low dose Cyclosporin A treatment increases live birth rate of unexplained recurrent abortion - initial cohort study
Yi Ling1, 2, Yuanhua Huang1, *(), Caixia Chen1, Jilong Mao1, Hongyu Zhang1
1 Affiliated Hospital of Hainan Medical College, Haikou, China
2 Department of Obstetrics and Gynecology, Southern Medical University, Guangzhou, China
Download:  PDF
Export:  BibTeX | EndNote (RIS)      
Abstract  
Background and objective: Pregnancy is similar to allogeneic transplantation. Eighty percent of unexplained recurrent spontaneous abortions (URSA) relate to disturbances of immune regulation. Cyclosporin A (CsA) is a immunosuppressant widely used after organ transplantation and to treat autoimmune disease. Animal studies show that low dose of CsA could induce maternal-fetal immunity tolerance while enhance trophoblast invasion. So far no clinical trial reported on the effect and safety of cyclosporin A treatment for URSA has been published. The objective of this study was to explore the effect, safety, and mechanism of low-dose CsA treatment in human patients in order to find a novel therapy to treat URSA. Materials and Methods: Eighty-six patients with eligible URSA treated at the clinic of the present hospital were included in this study from December 2009 to December 2012. The research was approved by the Ethics committee. Through a clinical study with prospective non-randomized controlled trials, the patients were divided into CsA treatment group (n = 66 cases) and in control group (n = 20 cases) based on the patients’ choice. Both groups started treatment as soon as the pregnancy test was positive. Patients in the treatment group were treated with oral CsA 100 mg/day for 30 days. Patients in the control group were treated with progesterone 20 mg im per day until 12 weeks of gestation. Cytoimmunology test of CD3, CD4, CD8, CD4/8, CD4/25, CD19/21, and Th/Ts were examined before and after the treatment in both groups. Clinical consequences of mothers and fetuses were followed up and recorded. Live birth rate and cytoimmunology markers and their change before and after the treatment were analyzed and compared between the two groups. Results: The live birth rate was significantly higher in study group (41/66, 62.1%) than in the control group (6/20, 30.0%) (p < 0.001). There was no obvious side effect and adverse consequence in the pregnancy women. No IUGR or birth defect was observed in fetus in this study. After CsA treatment, CD3 level in maternal blood was higher in successful group than abortion group but CD8 level was decreased after CsA treatment. Conclusions: Low-dose CsA treatment increases live birth rate of unexplained recurrent abortion. No maternal-fetal adverse consequence was observed in this study and it is safe in clinic use. The mechanism of CsA therapy may be related to immune regulation which may favor the success of pregnancy.
Key words:  Cyclosporin A      Unexplained recurrent spontaneous abortion (URSA)      Progesterone      Live birth rate      Cytoimmunology markers     
Published:  10 April 2017     
*Corresponding Author(s):  YUANHUA HUANG     E-mail:  huangyuanhuasci@163.com

Cite this article: 

Yi Ling, Yuanhua Huang, Caixia Chen, Jilong Mao, Hongyu Zhang. Low dose Cyclosporin A treatment increases live birth rate of unexplained recurrent abortion - initial cohort study. Clinical and Experimental Obstetrics & Gynecology, 2017, 44(2): 230-235.

URL: 

https://ceog.imrpress.com/EN/10.12891/ceog3375.2017     OR     https://ceog.imrpress.com/EN/Y2017/V44/I2/230

[1] J.H. Check, A. DiAntonio, D.L. Check, M.P. Dougherty, G. Diantonio. A study to determine if estrogen (E) is needed to induce de novo progesterone (P) receptors on gamma/delta t cells as evidenced by determining the degree of rise of progesterone induced blocking factor (PIBF) following P exposure in males[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 419-420.
[2] E. Kadour-Peero, S. Khoury, J. Awad, L. Shpritz, L. Chen-Konak, C. Shechner, L. Saiegh. Determination of estradiol and progesterone concentrations in human scalp hair[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 268-271.
[3] R. Csorba, P. Tsikouras, A. Bothou, S. Zervoudis, G. Iatrakis, X. Anthoulaki, D. Deuteraiou, A. Chalkidou, G. F. von Tempelhoff. Air travel during pregnancy: an update review and practical recommendation[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(6): 862-866.
[4] Shun Akaeda, Daiki Kobayashi, Kyoko Shioda, Mikio Momoeda. Relationship between serum progesterone concentrations and pregnancy rates in hormone replacement treatment-frozen embryo transfer using progesterone vaginal tablets[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(5): 695-698.
[5] P. Bakas, M. Simopoulou, P. Panagopoulos, N. Salakos, Ch. Siristatidis. Luteal phase progesterone and estradiol concentrations and their relation to the outcome of IVF/ICSI cycles with controlled ovarian stimulation[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(5): 727-730.
[6] J.H. Check, J. Liss, D. Check. The beneficial effect of luteal phase support on pregnancy rates in women with unexplained infertility[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(3): 447-449.
[7] J.H. Check, M.P. Dougherty. Use of sympathomimetic amines to correct premenstrual urticaria and anaphylaxis[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(2): 309-312.
[8] M.M. Khadra, M.A. Freij, Z.A. Al-Mazaydeh, S.E. Al-Mashhrawi, B.O. Rahhal, S.S. Saleh, R.M. Kilani, L.H. Tahtamouni. Factors influencing successful pregnancy outcomes in IVF cycles among Jordanian infertile couples[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(6): 855-860.
[9] J.H. Check. Pros and cons of the use of progesterone to reduce miscarriage rates[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(5): 652-655.
[10] L.E. Prado Correia, B.C. de Almeida, E. Chada Baracat, I. Silva, J.M. Soares Júnior, C.E. Bonduki, M. Abi Haidar. Efficacy and effects of transdermal hormone therapy in postmenopausal women[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(5): 735-740.
[11] J.H. Check. Intractable severe peri-ovulatory sneezing abrogated by injection of human chorionic gonadotropin[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(5): 781-781.
[12] M.B. Celtemen, P. Telli Celtemen, N. Bozkurt, C. Karakaya, S. Elberg, R.H. Gursoy. Follicular fluid anti-Müllerian hormone, inhibin-A, progesterone, and estradiol level differences in patients under controlled ovarian stimulation[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(2): 166-169.
[13] E. Djakovic, S. Rakic. Depression, anxiety, and stress after preterm delivery: role of previous progesterone therapy[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(2): 214-217.
[14] J.H. Check, J. Aly. Improving the chance of successful implantation – part 2 – Circumventing immune rejection and the fetal semi-allograft[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(1): 9-13.
[15] P. Bakas, M. Creatsa, P. Panagopoulos, N. Vlahos, E. Papadakis, M. Simopoulou. Outcome and recurrence risk of premature progesterone rise in IVF/ICSI cycles using GnRH antagonists for pituitary down-regulation[J]. Clinical and Experimental Obstetrics & Gynecology, 2018, 45(1): 44-47.
No Suggested Reading articles found!