Glucocorticoid therapy in assisted reproduction

Abstract

As glucocorticoids are well-known as important regulators of stress and the immune system, their function and clinical use have elicited substantial interest in the field of reproduction. In particular, the effect of glucocorticoid therapy on endometrial receptivity during assisted reproduction, including in vitro fertilization (IVF) cycles, has led to a great deal of interest and controversy. However, previous studies have not been able to provide consistent and reliable evidence due to their small, non-controlled designs and use of different criteria. Considering the potential risk of exposure to glucocorticoids for mothers and fetuses in early pregnancy, the use of glucocorticoids in IVF cycles should be carefully evaluated, including the balance between risk and benefit. To date, there is no conclusive evidence that the use of glucocorticoids improves the pregnancy rate in IVF cycles with unselected subjects, and a further investigation should be considered with a proper study design.

Good practice recommendations on add-ons in reproductive medicine

“…With regards to the safety of glucocorticoid administration, animalstudies have reported foetal growth retardation, cardiovascular, metabolic, neuroendocrine disorders, and teratogenic effects. In humans, increased risk of miscarriage, preterm births, gestational hypertension, and diabetes have been reported, even if the data are limited ( Kim, 2021 ).…”

Elevated follicular cortisone level is a negative predictor of clinical pregnancy in women undergoing fresh embryo transfer

“…Additionally, glucocorticoids are reported to affect local inflammation and immune response in the endometrium [ 37 ], potentially affecting embryo implantation. The use of glucocorticoids in assisted reproduction to improve the embryo implantation rate has been proposed, though controversial [ [38] , [39] , [40] ]. A Cochrane meta-analysis [ 41 ] of 13 randomized controlled trials (RCTs) found that glucocorticoid therapy led to no significant improvement in pregnancy rates.…”

Metabolic Consequences of Glucocorticoid Exposure before Birth

“…In pregnant women, fetal GC overexposure can also be caused exogenously by maternal treatment with synthetic GCs for a variety of clinical conditions such as congenital adrenal hyperplasia, rheumatoid arthritis, asthma, and other inflammatory conditions [ 30 ]. Synthetic GCs have also been given for immune suppression to women planning pregnancy either with transplanted organs or using in vitro fertilization (IVF) procedures, which leads to excess embryonic GC exposure from the earliest stages of development [ 31 , 32 ]. In addition, later in pregnancy, antenatal treatment with synthetic GCs is given routinely to women threatened with pre-term delivery to improve neonatal viability of their infants, although in 50% of cases delivery does not actually occur until much nearer to full term [ 30 ].…”