# Peri-Transfer Glucocorticoid Therapy in Oocyte-Donation IVF Bridging the Immunological Gap

## TL;DR

This review examines the use of glucocorticoids during IVF with oocyte donation, finding limited evidence for their effectiveness and highlighting the need for more research.

## Contribution

The paper consolidates current evidence on glucocorticoid therapy in oocyte donation IVF, emphasizing the lack of robust data and the need for targeted studies.

## Key findings

- Current data do not support routine use of glucocorticoids in oocyte donation IVF.
- Short-term, low-dose glucocorticoids may be considered for specific immunological profiles.
- More rigorous randomized studies are needed to determine the safety and efficacy in this patient group.

## Abstract

In vitro fertilisation via oocyte donation is a unique reproductive technique in which the embryo is fully separate from the receiver. This compels the immune system to exert more effort at the interface between the uterus and the remainder of the body. This setting has maintained interest in peri-transfer glucocorticoid treatment as a possible approach to modify endometrial immunity and enhance implantation. Nevertheless, the data for this procedure are disjointed and mostly derive from investigations on autologous in vitro fertilisation. This narrative review consolidates contemporary evidence on endometrial immunology in oocyte donation cycles, analysing the mechanistic basis, clinical results, and constraints related to peri-implantation glucocorticoid therapy. Outcomes from randomised studies in autologous cycles consistently demonstrate that there is no advantage in live birth rates, but the claimed improvements in clinical pregnancy rates are from heterogeneous and low-quality data. Limited research exists on people who have received oocyte donations. The majority are diminutive and non-random, often integrating glucocorticoids with other therapies such as antibiotics, granulocyte colony-stimulating factor, or endometrial damage. These designs inhibit the dissociation of the independent impact of glucocorticoids. Recent comprehensive randomised studies on recurrent implantation failure further demonstrate the lack of advantages in live births and highlight possible safety issues. The current data do not support the usual use of peri-transfer glucocorticoids in oocyte donation for in vitro fertilisation; nevertheless, short-term, low-dose treatment may be justified in meticulously chosen immunological profiles. There is an urgent need for rigorously designed randomised studies focused only on oocyte-donation recipients to elucidate the therapeutic effectiveness, safety, and suitable clinical context for glucocorticoid treatment in this expanding patient demographic.