Does glucocorticoid therapy in the peri-implantation period have an impact on IVF outcomes?

PURPOSE OF REVIEW: Failure of the embryo to implant remains the major limiting step in assisted reproductive techniques success rates. The existing evidence supports a possible role of glucocorticoids in improving the intrauterine environment and therefore embryo implantation. The present study aims to summarize the available evidence and make recommendations about the use of glucocorticoids. RECENT FINDINGS: A recent meta-analysis on glucocorticoids to improve embryo implantation showed no beneficial effect in the routine IVF/intracytoplasmic sperm injection population, although a subgroup analysis of women undergoing IVF did show a borderline improvement in pregnancy rates. Studies on women with autoantibodies or treatment cycles in which assisted hatching is performed have also indicated a benefit from glucocorticoid cotreatment. No significant improvement in pregnancy rates, however, has been demonstrated in women with recurrent implantation failure in whom assisted hatching is performed in combination with glucocorticoids. Conflicting results have been reported on the use of glucocorticoids to improve the ovarian response. SUMMARY: Although evidence to support the empirical use of glucocorticoids to improve implantation is insufficient, these may be beneficial in specific patient groups. More studies are required to confirm the efficacy and safety of adjuvant glucocorticoid therapy, and they should only be empirically used in the context of randomized controlled trials.     

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Coordinating Canada's research response to global health challenges: the Global Health Research Initiative

The Global Health Research Initiative (GHRI) involving the Canadian International Development Agency, the Canadian Institutes of Health Research, Health Canada and the International Development Research Centre seeks to coordinate Canada's research response to global health challenges. In light of numerous calls to action both nationally and internationally, an orientation to applied health policy and systems research, and to public health research and its application is required to redress global inequalities in wealth and health and to tackle well-documented constraints to achieving the United Nations Millennium Development Goals. Over the last four years, the GHRI has funded close to 70 research program development and pilot projects. However, longer-term investment is needed. The proposed dollars 100 million Teasdale-Corti Global Health Research Partnership Program is such a response, and is intended to support teams of researchers and research users to develop, test and implement innovative approaches to strengthening institutional capacity, especially in low- and middle-income countries; to generating knowledge and its effective application to improve the health of populations, especially those most vulnerable; and to strengthen health systems in those countries. While Canada stands poised to act, concerted leadership and resources are still required to support "research that matters" for health and development in low- and middle-income countries.