Objective: To examine the effect of beta-cyclodextrin piroxicam treatment for priming of the uterus on the
pregnancy outcome of IVF–embryo transfer (ET) programs.
Design: Prospective, randomized, double-blinded placebo-controlled clinical study.
Setting: Large urban medical center.
Patient(s): One hundred eighty-eight consecutive cycles of fresh IVF–ET and 78 cycles of frozen–thawed ET.
The patients underwent IVF because of tubal, male infertility, unexplained, or endometriosis factors. They
were randomly divided into treatment and control groups.
Intervention(s): In the treatment group, 94 cycles in fresh ET and 39 cycles in frozen–thawed ET the patients
received an oral dose of 10 mg of piroxicam. In the control group, the same number cycles corresponding to
the treatment group were treated with placebo. Both groups started piroxicam or placebo treatment 1–2 hours
before ET. Patients and staff were blinded to the treatment.
Main Outcome Measure(s): Implantation rate (IR) and pregnancy rate (PR).
Result(s): Piroxicam increased significantly IR (18.7%) and PR (46.8%) compared to the control group (8.6%
and 27.6%, respectively) in fresh cycles. With the exception of an unexplained factor, patients with the tubal,
male infertility, or endometriosis factor had significantly higher PR in the treatment group compared to the
control group. The beneficial effect of piroxicam was found in patients less than 40 years old, but was not
found in patients more than 40 years. In frozen–thawed cycles, there were statistically significant differences
between the treatment group and the control group in IR (9.4% vs. 2.3%) and PR (25.6% vs. 7.7%),
respectively.
Conclusion(s): Our study showed that piroxicam increases IR and PR after IVF–ET in both fresh and
frozen–thawed ET cycles. The beneficial effect seems to be more remarkable in patients less than 40 years old
with tubal, male infertility, or endometriosis factors. These results suggest that piroxicam treatment before ET
is very effective in the priming of a uterus suitable for embryo implantation. This is the first study to
investigate the possible consequence of piroxicam for improving the PR after IVF–ET. (Fertil Steril 2004;
82:816 –20. ©2004 by American Society for Reproductive Medicine.)
Key Words: beta-Cyclodextrin piroxicam, pregnancy outcome, uterine contractility