IVF is the most successful fertility treatment available today. Despite that fact,
many embryos which are transferred into the uterus will fail to implant. Some scientists
believe that some of these failed implantations may be due to problems with a patient’s immune
system. Some doctors have used a potent medication to suppress the immune system
at the time of an embryo transfer. Does this improve the IVF success rate? Stay tuned!
Prednisone belongs to a class of drugs known as corticosteroids. Corticosteroids
suppress the immune system in a number of different ways and are also known
to reduce inflammation in the body. In the past,
some IVF doctors have used prednisone in an attempt to improve IVF success rates. However,
the scientific studies that were conducted using prednisone in IVF cycles have not been very good.
Recently, a very well done study was published that tried to answer the
question of whether prednisone was an effective treatment for
patients who had a history of recurrent implantation failure.
For this study, patients were recruited who have undergone 2 or more embryo transfer
cycles with good-quality embryos but did not achieve a clinical pregnancy. On average,
recruited patients had three failed transfers. The patients must also be
planning to do a frozen embryo transfer and have one or more good quality embryos to use.
To prepare the uterus for a frozen embryo transfer, all patients took estrogen to
thicken the uterine lining followed by progesterone to prepare the lining for
implantation. These are routine medications that are given to patients who are attempting
pregnancy with frozen embryos. However, the patients were split-- into two groups. Group
one received prednisone twice a day every day at the same time they started taking estrogen.
Group 2 took a placebo or fake pill. Neither the patients nor the doctors knew who was
getting the real prednisone versus the fake. If the patients became pregnant,
they continued to take the real or fake medication until they were 12 weeks pregnant.
Ultimately, 715 patients were enrolled in the study. 357 ---received prednisone and
258 received placebo. Because they started the prednisone before the embryo transfer,
they could determine first whether prednisone increased the chances
for an embryo to implant. However, th-e results were no different between the two groups. Just
over half of the patients had a positive pregnancy test in each group. This is powerful evidence that
prednisone does not improve the chance for pregnancy in frozen embryo transfer cycles.
Since the medication was continued after pregnancy in those people with a positive pregnancy test,
this study could also determine whether prednisone could reduce the risk of very
early or later miscarriage. Very early pregnancy losses are known by fertility
doctors as biochemical pregnancy losses. These are losses that occurred after
a positive pregnancy test but before a pregnancy could be seen with ultrasound.
The results -showed that the patients who used prednisone had a higher risk
for a biochemical pregnancy loss. The prednisone group saw 17% of the
pregnancies lost after a positive pregnancy test. The placebo group
saw only a 10% rate of loss. This was more than could be attributed to just chance.
For later miscarriages, there was no difference. About 13% of the pregnancies
in each group were lost in the first trimester and around 2% were lost in the 2nd trimester.
Ultimately, the percentage of transfers that resulted in a live birth were
almost exactly the same. Around 38% of the transfers in each group had a live birth.
Our Infertility TV Bottom line is this. Using prednisone in IVF cycles does not improve the
chance that you will become pregnant and does not improve the odds that you will have a live birth.
If your fertility specialist insists on using prednisone, its time to get a second opinion.