Prednisolone – the fertility wonder drug?

24 Apr Prednisolone – the fertility wonder drug?

When it comes to fertility medication, some are more controversial than others. A steroid called Prednisolone, or Prednisone, is one of them. Some call it a fertility wonder drug. Others are more sceptical. So is it worth trying or a waste of money? Let’s look at the evidence.

Prednisolone is a form of corticosteroid sometimes prescribed to fertility patients with recurrent miscarriage, elevated natural killer (NK) cells or implantation issues. Prednisolone is basically a synthetic hormone that helps suppress immune responses.

Prednisolone isn’t just prescribed to fertility patients. As an anti-inflammatory and immuno-suppressant, it can treat a range of other conditions. These include allergies, blood disorders, respiratory problems skin problems and sperm antibodies.

But while Prednisolone is well regarded in general medicine, the jury is out on its tangible benefits to fertility patients. IVF consultant Lord Winston is distinctly wary of it. Studies have looked at Prednisolone’s alleged role in reducing miscarriage and the threat from natural killer cells. Most are small-scale.

An Australian study used low-dose Prednisolone alongside blood-thinner Clexane to try to suppress natural killer cells in women with recurrent miscarriages. The results were quite promising. But the number of participants involved was minimal, making it hard to draw firm conclusions.

Other studies abound. Research in 2016 found benefits in combining Prednisone and low-dose aspirin in IVF protocols, starting three months before ovulation induction. (We certainly see this combination regularly in repeat FETs.) A 2016 study was wary, calling immune-suppression ‘a faulty premise’. And a 2018 study saw better ongoing pregnancy rates with the use of Prednisone, aspirin, and vitamins B and D.

When prescribed to female fertility patients, Prednisolone is generally used for a short period (6 to 10 weeks). Doses vary, but 5 mg a day is common. Be wary if your clinic proposes more than 25 mg daily. Prednisolone pills are normally started on embryo transfer day or a few days earlier. But you may be told to start them when you start your stimulating medication.

Prednisolone is more often prescribed for donor-egg, donor-embryo and FET cycles. IVF protocols don’t include it so much, probably because follicle stimulation is complicated enough as it is.

If your HCG blood test is negative, your fertility medication, including Prednisolone, will be stopped. If it’s positive, you’ll probably be told to continue until you’re nine weeks pregnant. Your dosage may be tapered off in the final week.

Like any drug, there are risks involved with taking steroids. Common side effects of Prednisolone include irritability, anxiety and sleep disturbance. Taking corticosteroids in pregnancy could also affect fetal growth. The question is, are the benefits worth the risk?

Deciding whether to try a fertility drug like Prednisolone isn’t easy. It could make that crucial difference or be a dead end. Unlike intralipids, with which it is often combined, Prednisolone pills are cheap. But they are not ‘vitamins’. Prednisolone can affect your metabolism, increase the risk of diabetes and change your bone structure.

Talk to your fertility clinic about Prednisolone. It’s not for every patient. Make sure you’re fully aware of what’s involved. Until a large-scale, randomised trial is carried out, its true benefits in assisted reproduction are not clear-cut.