IVFfertilisationtreatment to be unsuccessful
These are steroid hormones that can either be made in the body or in a lab. Synthetic corticosteroids, such as prednisolone, have a potent effect on suppressing the immune response and dampening inflammation.
an outdated view
essential part of normal embryo implantationunable or unwilling to allow embryo implantation
NK“embryo killer” cellsin an effort to reduce these cells
NKNKnot useful in predicting infertility or miscarriage
The false perception corticosteroid drugs are effective and safe is encouraged by records from IVF pregnancies in women taking corticosteroids for autoimmune disorders. The overall, relatively low chance of adverse effects in this rare patient group has prompted broader use of corticosteroids when there is no immune disorder.
But although their pregnancies usually progress normally, there is a higher chance of pregnancy problems and an elevated rate of fetal malformations for women taking corticosteroid drugs. Prescribing doctors judge the potential benefit is worth the minor risk, but this is arguable for women without autoimmune disorders.
A key problem is there is no convincing evidence for any benefit on fertility. A recent meta-analysis drawing together data from 13 studies showed only a borderline effect of using a certain type of corticosteroid in a subgroup of 650 women undergoing IVF, and no effect in a larger group of 1,759 women. Importantly, there was no overall benefit for delivery of a live infant after IVF.
Few studies follow up the health outcomes of the infant after corticosteroid use in IVF. When birth outcomes have been tracked, data suggest adverse effects similar to those in women taking corticosteroids for autoimmunity. One study of 311 women who used corticosteroid drugs beyond the first trimester showed a 64% increase in miscarriage and around a two-fold increase in preterm births.
A larger study showed corticosteroid use during early pregnancy is linked with cleft lip and palate in infants. Fetal organ structures develop most rapidly in the first trimester. Given the pivotal role of immune cells in fetal growth, these effects are hardly surprising. It is unreasonable to claim that using low doses, or limiting drug use to the first 12 weeks, removes the risk.
Proven therapies for infertility associated with implantation failure and unexplained miscarriage are urgently needed, but corticosteroids are not the answer. While in the specific circumstance of autoimmunity some women benefit from these drugs, in most women, suppressing the immune response is likely to cause more harm than good.
This article was originally published on The Conversation. Read the original article.Jump to next article