Steroids in infertility treatment may lead to birth defects

Sydney: While steroids are increasingly used to treat infertility in women suffering from repeated IVF failure and recurrent miscarriage, they can actually interfere with embryo implantation, and may have harmful effects on pregnancy and the child, says a study.

"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," said lead researcher Sarah Robertson, Professor at Robinson Research Institute, University of Adelaide in Australia.

"Corticosteroids such as prednisolone may impair healthy pregnancy, which may lead to poorer long-term outcomes for the baby," she noted.

Many women receive corticosteroids in the belief that reducing immune cells called "natural killer" cells will facilitate a pregnancy. However, this belief is mistaken, as despite their alarming name these cells are actually required for healthy pregnancy.

There is a great deal of medical and consumer misunderstanding about the role of the immune system in fertility and healthy pregnancy, Robertson said.

"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," Robertson explained.

"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," she added.

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, Robertson said.

"We argue that unless overt immune pathology is evident, utilisation of corticosteroids is not warranted and may be harmful," the study, published in the journal Human Reproduction, noted.

"The exception would be in specific cases where the patient has a diagnosed autoimmune condition, but those cases are rare," Robertson observed.