Australasian Science: Australia's authority on science since 1938

IVF Steroid Treatment May Do More Harm than Good

Doctors and patients have been warned about the use of corticosteroids to treat infertility in women because of a link to miscarriage, preterm birth and birth defects.

Writing in Human Reproduction (http://tinyurl.com/gomwzl6), researchers from The University of Adelaide’s Robinson Research Institute, led by Prof Sarah Robertson, say that widespread use of corticosteroids such as prednisolone is not warranted given a high degree of suspicion that they can interfere with embryo implantation and may have harmful effects on pregnancy and the child.

Corticosteroids are increasingly used to treat infertility in women with repeated IVF failure and recurrent miscarriage. Many women receive the drug in the belief that reducing immune cells called “natural killer” cells will facilitate a pregnancy. However, this belief is mistaken as these cells are actually required for healthy pregnancy.

Robertson says there is a great deal of medical and consumer misunderstanding about the role of the immune system in fertility and healthy pregnancy. “Steroid drugs such as prednisolone act as immune suppressants, preventing the body’s immune system from responding to pregnancy. But by suppressing the natural immune response, these drugs may lead to further complications,” she says.

“The immune system plays a critical role in reproduction and fertility. Natural killer cells and other immune cells help to build a robust placenta to support healthy foetal growth. But if we suppress or bypass the body’s natural biology, there can be dire consequences that don’t appear until later,” she says.

“For example, suppression of the immune system through inappropriate use of these drugs is linked to impaired placental development, which in turn elevates the risk of miscarriage, preterm birth and birth defects.”

Research shows that women taking corticosteroids over the first trimester of pregnancy have a 64% increase in miscarriage. The risk of preterm birth is more than doubled, and their children have an elevated risk of birth defects, including a 3–4 times greater risk of cleft palate.

“We believe IVF doctors should not be offering this treatment to most patients, and should discuss concerns with women who request it, Robertson says. “The exception would be in specific cases where the patient has a diagnosed autoimmune condition, but those cases are rare.”