<p>Corticosteroids Prior to Embryo Transfer in Assisted Reproduction in Women with Crohn’s Disease and Ulcerative Colitis – A Nationwide Cohort Study</p>

Abstract

Purpose: Former studies have suggested that women with Crohn's disease (CD) and ulcerative colitis (UC) have a decreased chance of a live born child after assisted reproductive technology (ART) treatment. It is debated whether corticosteroids before ART may improve outcomes, either by decreasing inflammatory bowel disease-related inflammation or increasing endometrial receptivity. We examined the efficacy of corticosteroids before embryo transfer in women with CD and UC. Patients and Methods: Our cohort study is based on nationwide Danish health registries, comprising women with CD and UC receiving an embryo transfer (1 January 2006 through 2017). Exposed cohorts constituted women with CD and UC who had received corticosteroids within three months before embryo transfer, and the unexposed cohorts women with CD and UC who did not receive corticosteroids. Our primary outcome was live birth. We controlled for multiple covariates in the analyses. Results: We examined 2408 embryo transfers. In patients with CD, 114 embryo transfers were preceded by a corticosteroid prescription, and 964 were not. The corresponding numbers in UC were 122 and 1208, respectively. The adjusted odds ratio (aOR) for live birth in women with CD receiving corticosteroids before embryo transfer, relative to women with CD not receiving corticosteroids, was 0.89 (95% CI 0.49-1.63). The corresponding aOR in UC was 0.98 (95% CI 0.55-1.74). Conclusion: Corticosteroids prior to ART in women with CD and UC did not increase the chance of a live born child. The exact impact of corticosteroids prior to embryo transfer in patients with CD and UC still remains to be determined.

Gastroenterology team members’ knowledge and practices with fertility therapy for women with inflammatory bowel disease

“…ART efficacy was not reduced in women with IPAA overall; however, live birth rates were 64% lower in women with a failed IPAA. 16 , 17 , 19 – 23 , 27 – 29 We found no difference in fertility therapy referral rates between participants from the United Kingdom and Australia, which may reflect the relatively good access to government-subsidised ART in both jurisdictions.…”

“…Data on ART in IBD patients have emerged over the last decade but have often been overlooked in medical education concerning IBD and reproduction. 16 – 18 , 20 – 23 , 27 – 29 Respondents who were more optimistic about the efficacy of ART in women with IBD, including in the subgroup with prior IBD-related surgery, were significantly more likely to refer for ART compared to those who thought ART was less effective or were uncertain about its efficacy. Although data are limited, a recent meta-analysis identified ART success rates in women with UC to be comparable to the general population and women with CD to have 33% reduced live birth rates but comparable pregnancy rates.…”

“…Although data are limited, a recent meta-analysis identified ART success rates in women with UC to be comparable to the general population and women with CD to have 33% reduced live birth rates but comparable pregnancy rates. 16 – 23 , 27 – 29 The reduced live birth rates in women with CD was largely contributed to by women with prior CD-related surgery, which was associated with a 49–71% reduced live birth rate. ART efficacy was not reduced in women with IPAA overall; however, live birth rates were 64% lower in women with a failed IPAA.…”

The Efficacy of Assisted Reproduction in Women with a Wide Spectrum of Chronic Diseases – A Review

“…A study on this subject was published in 2020 but was not included as part of selected papers for this review as the analyses did not use an external control group, but compared live births in women with chronic inflammatory bowel disease receiving corticosteroids to women with chronic inflammatory bowel disease not receiving corticosteroids. 31 The study found that the adjusted OR for live birth in women with Crohn’s disease receiving corticosteroids before embryo transfer, relative to women with Crohn’s disease not receiving corticosteroids, was 0.89 (95% CI: 0.49 to 1.63), and the corresponding result in ulcerative colitis was 0.98 (95% CI: 0.55 to 1.74).…”

Ovarian reserve and IVF outcomes in patients with inflammatory bowel disease: A systematic review and meta-analysis

“… 7 , 8 , 9 Seven articles were excluded because the risk ratio was not provided or they did not have an appropriate control group. 10 , 11 , 12 , 13 , 14 , 15 , 16 Nine articles finally meet the eligibility criteria for inclusion. 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 There was almost perfect agreement between the two reviewers in judging eligibility of the citations (kappa statistic = 0.854).…”