Prednisolone and enoxaparin (clexane) therapy (‘the Bondi protocol’) for repeated IVF failure

PROBLEM: What is the impact of an empirical immune therapy protocol of prednisolone and enoxaparin (clexane) (the ‘Bondi protocol’) on women with repeated in vitro fertilization (IVF) failure? METHOD OF STUDY: This was a retrospective review of live birth outcomes conducted on all transfer cycles performed by a single clinician (GS) at IVFAustralia between February 2016 and April 2020. This study consisted of 1786 transfer cycles, including 460 cycles treated with the Bondi protocol and 1326 without. Women with repeated IVF failure were given the Bondi protocol based on blood NK cell activity. Primary outcome was live birth and statistical analysis was performed with GraphPad Prism software with significance for P‐values < .05. RESULTS: Overall ‘Bondi’ and ‘normal’ protocol cycles had similar rates of IVF/ICSI, fresh/frozen transfers and use of preimplantation genetic testing (PGT). Women given the Bondi protocol were older, had more previous cycles and had higher blood NK cell activity. There was no significant difference in live birth rates (Bondi 26%, normal 28%). Bondi protocol live birth rates per transfer cycle were as high as 40% in patients under 38 years old. The Bondi protocol was more effective as NK activity increased from ‘normal’ to ‘borderline’ to ‘high’. For high NK cell activity levels, live birth rates were over four times higher for women on the Bondi protocol (28%) than those on normal protocols (6%, P = .0007). CONCLUSION: This study describes a simple and relatively safe immune therapy protocol that may improve IVF success rates in women with evidence of immune dysfunction.