Glucocorticoids Do Not Improve Birth Rates in Assisted Reproduction, Meta-Analysis Confirms

Use of glucocorticoids around the time of implantation has no effect on live birth rates and mimimal effect on pregnancy rates, confirms a new meta-analysis.¹ Despite a lack of evidence supporting the practice,^2,3 glucocorticoids are sometimes used to help make the lining of the uterus more responsive to embryo implantation during in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

In a review of available randomized controlled trials investigating the use of glucocorticoids in IVF or ICSI, researchers analyzed data from 14 studies involving 1879 couples in which some women used glucocorticoids and some women did not. There was no evidence that use of glucocorticoids improved pregnancy rates. In a subgroup analysis, however, researchers found that among women undergoing IVF, those who used glucocorticoids had a borderline significantly higher pregnancy rate than those who did not use glucocorticoids. Adverse events were inconsistently or poorly reported in the studies that were reviewed, but available data on adverse events showed that there were no significant differences between study groups.

When looking at success in terms of delivery of a healthy baby, the success rate of IVF and ICSI is between 20% and 30%.³ According to Randall Hines, MD, director of the division of reproductive endocrinology and infertility at the University of Mississippi Medical Center, “That tantalizing hint of benefit may nevertheless encourage some practitioners to continue routine use of glucocorticoids for their IVF patients. When you have a therapy that doesn’t have significant risk and doesn’t impose significant burden on the patient in terms of cost or convenience, it’s hard for people to let go of it.”³

These findings are consistent with other studies that have shown that use of glucocorticoids have little to no effect on improving pregnancy and live birth rates in ICSI in subfertile couples.

Pertinent Points:
- Glucocorticoids do not improve live birth rates and should not be used routinely in assisted reproductive techniques.
- A minimal improvement in pregnancy rates was associated with use of glucocorticoids, but this finding should be interpreted cautiously, say the study authors.
- Use of glucocorticoids may have some benefit in terms of uterine receptivity for certain subsets of patients, such as those with unexplained infertility, endometriosis, recurrent implantation failure, or certain immunological conditions, but additional studies are needed to determine the specific role of this treatment in well-defined patient groups.

References:

1. Boomsma CM, Keay SD, Macklon NS. Peri-implantation glucocorticoid administration for assisted reproductive technology cycles. Cochrane Database Syst Rev. 2012;6:CD005996.
2. Ubaldi F, Rienzi L, Ferrero S, et al. Low dose prednisolone administration in routine ICSI patients does not improve pregnancy and implantation rates. Hum Reprod. 2002;17:1544-1547.
3. Anitei S. Steroids do not boost fertility. March 12, 2007. Available at: http://news.softpedia.com/news/Steroids-Do-Not-Boost-Fertility-49158.shtml. Accessed August 14, 2012.