14 DAY TRIAL // In vitro fertilization (IVF) is the last solution to which sterile couples resort and many physicians prescribe the steroid hormones called glucocorticoids, as they have powerful effects on triggering the body's inflammatory and immune responses, in order to make the lining of the uterus more receptive to embryo implantation.
But a new meta-analysis, made on 13 studies involving 1,759 couples who employed some form of IVF, shows that there's no clear health benefit induced by these hormones. "This meta-analysis shows that empirical use of glucocorticoids is not supported by evidence from studies," said lead review author, Carolien Boomsma, a researcher at the University Medical Centre Utrecht in the Netherlands. "Moreover, we don't know enough about the possible adverse effects of glucocorticoids in early pregnancy. Therefore, at present, glucocorticoids should not be prescribed in this way," said Boomsma.
The review compared success rates between women wanting to be mothers who took glucocorticoids around the time of embryo implantation and those who did not.
The review did not detect overall improvement in pregnancy rates when the IVF technologies were combined with glucocorticoid treatment.
Six of the researches, on 650 women, found a slightly higher pregnancy rate among women who took glucocorticoids combined with IVF, but the difference barely exceeded what could be named mere chance. "At present, glucocorticoids should not be offered as a routine procedure in women undergoing ART (assisted reproductive technologies), except in the context of well-designed studies," the reviewers conclude.
Glucocorticoids are known to be able to inflict infections or premature births. Even if the studies did not depict this negative effect, they were "poorly and inconsistently reported. Further research is needed to clarify both benefits and harms," said Boomsma.
Only three researches monitored actual birth rates, besides the simple pregnancy percentages. "Trials should be of sufficient duration to have live birth as their primary outcome," the authors say.
By now, IVF and ICSI techniques can deliver healthy babies only in 20 - 30 % of the cases. "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 inconvenience, it's hard for people to let go of it," said Dr Randall Hines, director of the division of reproductive endocrinology and infertility at the University of Mississippi Medical Center. "Future research may reveal that glucocorticoids do help specific subsets of infertile couples," the authors say.
Women with unexplained infertility, endometriosis, recurrent implantation failure or some immunological conditions may benefit from the glucocorticoid effects on uterine receptivity, but specifically focused researches should be developed.