Steroids that could help women get pregnant may, ironically, be responsible for miscarriage, preterm birth, and birth defects later on in the gestation period. These findings from an Australian study
urge doctors to reexamine whether prescribing corticosteroids to women trying to conceive is truly warranted.
Infertility is more widespread than we imagine - around the world, over 48 million couples experience fertility problems. For couples who have trouble conceiving naturally, assisted reproductive techniques like in vitro fertilization (IVF) may be an effective treatment. However, though IVF has been around for decades, the technique is not yet perfected. This, combined with other biological factors, means that the success rate for IVF is still relatively low. The average per-cycle success rate for conceiving a baby with IVF is around 20-35 percent, and that’s being very optimistic.
To help women with repeated IVF failure, doctors prescribe corticosteroids. The intent is to lower the woman’s immune system so that her body will be more receptive to the embryo implanting in her uterus. But while this may help women to achieve pregnancy, researchers note that the steroids have adverse effects on the baby further down the gestation period.
"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," said Sarah Robertson, professor at the University of Adelaide who led the study.
Lowering the immune system appears to be unsafe for the baby in the womb. "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 fetal growth. But if we suppress or bypass the body's natural biology, there can be dire consequences that don't appear until later," said Robertson.
"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."
The researchers found that women who were exposed to corticosteroids during their first trimester were more likely to experience a miscarriage (64 percent increased risk). The risk for preterm birth, which is fraught with complications for the mother and the baby, is nearly doubled. And the risk for birth defects, such as cleft palate, is increased by nearly 4 times.
"Our main message to clinicians and to women hoping to achieve pregnancy is that they should be focused on achieving good-quality pregnancy and the life-time health of the child, not just getting pregnant," Robertson reiterated.
"We believe IVF doctors should not be offering this treatment to most patients, and should discuss concerns with women who request it. The exception would be in specific cases where the patient has a diagnosed autoimmune condition, but those cases are rare," Robertson added.
Additional source: University of Adelaide via EurekAlert!