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Abstract Objective To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO CRD42023449655 InjectionIn Injection In IVFICSI IVF ICSI (IVF/ICSI alone PubMed Cochrane 2023 included ORs (ORs endpoints 95 CIs. CIs . (CIs) I statistics 54The The 5 4 2829 2 829 2,82 1312 1 312 1,31 46.37%. 4637 46.37% 46 37 (46.37%) OR 1.48 148 48 1.012.18 101218 1.01 2.18 01 18 1.01-2.18 1.89, 189 89 (1.89 1.143.14. 114314 1.14 3.14 14 3 1.14-3.14) nonimmunosuppressive non immunosuppressive treatment 113 13 1.13 0.881.46 088146 0.88 1.46 0 88 0.88-1.46 149 49 1.49 1.072.09. 107209 1.07 2.09 07 09 1.07-2.09) 1.34 134 34 0.762.36, 076236 0.76 2.36 , 76 36 0.76-2.36) 1.36 136 0.762.42. 076242 2.42 42 0.76-2.42) rates However size caution CRD CRD4202344965 202 9 (CIs 282 82 2,8 131 31 1,3 463 46.37 (46.37% 1.4 012 1.012.1 10121 101 1.0 218 2.1 1.01-2.1 1.89 8 (1.8 143 1.143.14 11431 114 1.1 314 3.1 1.14-3.14 11 881 0.881.4 08814 088 0.8 146 0.88-1.4 072 1.072.09 10720 107 209 2.0 1.07-2.09 1.3 762 0.762.36 07623 076 0.7 236 2.3 7 0.76-2.36 0.762.42 07624 242 2.4 0.76-2.42 CRD420234496 20 28 2, 1, 46.3 (46.37 1. 1.012. 1012 10 21 2. 1.01-2. 1.8 (1. 1.143.1 1143 3. 1.14-3.1 0.881. 0881 08 0. 0.88-1. 1.072.0 1072 1.07-2.0 0.762.3 0762 23 0.76-2.3 0.762.4 24 0.76-2.4 CRD42023449 46. (46.3 1.012 1.01-2 (1 1.143. 1.14-3. 0.881 0.88-1 1.072. 1.07-2. 0.762. 0.76-2. CRD4202344 (46. 1.01- ( 1.143 1.14-3 0.88- 1.072 1.07-2 0.762 0.76-2 CRD420234 (46 1.14- 1.07- 0.76- CRD42023 (4 CRD4202 CRD420 CRD42 CRD4