This systematic review and meta-analysis evaluates the efficacy of aspirin combined with prednisone or prednisolone in patients undergoing in vitro fertilization (IVF) or experiencing recurrent implantation failure (RIF). We conducted comprehensive literature searches in PubMed, Web of Science, Embase, CNKI, CBM, and CQVIP from 1984 to December 2023. Ten randomized controlled trials involving 2902 patients were included. Study quality was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale.

Pooled analysis demonstrated that the combination therapy significantly improved clinical pregnancy rates (RR = 1.13; 95% CI: 1.03–1.23) and implantation rates (RR = 1.27; 95% CI: 1.01–1.60) compared to placebo or no treatment. Subgroup analysis revealed that ANA-positive patients particularly benefited from improved implantation rates. However, no statistically significant differences were observed in live birth rates, miscarriage rates, or fertilization rates between the intervention and control groups.

The findings suggest that adjuvant therapy with aspirin plus prednisone or prednisolone may enhance key reproductive outcomes in IVF/RIF patients, especially in specific subpopulations such as ANA-positive individuals. While these results support the potential efficacy of immunomodulatory approaches in assisted reproduction, further large-scale, rigorously designed randomized controlled trials are needed to validate these findings and elucidate the comparative effectiveness between prednisone and prednisolone in combination regimens.

Xin Tong, Master of Epidemiology and Health Statistics, Nanjing Medical University, is an Associate Chief Pharmacist and Clinical Pharmacist of Women’s Hospital of Nanjing Medical University. He serves as a Youth Committee Member of the China Association of Chinese Medicine and has led multiple research projects funded by the National Administration of Traditional Chinese Medicine, Nanjing Medical University, and provincial pharmaceutical associations. A total of 30 papers have been published in SCI and core Chinese journals, his work has been recognized through several Outstanding Paper Awards from professional associations including the Jiangsu Pharmaceutical Association and Nanjing Pharmaceutical Association. He actively contributes to academic peer review as a referee for the Journal of Otolaryngology and Ophthalmology of Shandong University and Asia-Pacific Traditional Medicine. His professional expertise spans clinical pharmacy, pharmaceutical research, and evidence-based practice in traditional medicine. He maintains particular focus on pharmacoepidemiology and therapeutic evaluation within integrative medicine settings.