Prednisone fails to improve implantation failure in IVF patients: JAMA

Prednisone therapy did not increase live birth rate over placebo in patients with recurrent implantation failure, says an article published in the Journal of American Medical Association.

Failure to implant remains a significant obstacle to in vitro fertilization. Although there is insufficient evidence to support its effectiveness, prednisone is frequently used as an immune-regulatory agent to increase the likelihood of implantation and pregnancy. In order to assess the effectiveness of 10 mg of prednisone to a placebo on live birth among women who have experienced repeated implantation failure, Yun Sun and colleagues undertook this study.

This was a randomized, double-blind, placebo-controlled clinical investigation that was carried out at 8 Chinese reproductive clinics. Between November 2018 and August 2020, all eligible women who had a history of two or more failed embryo transfer cycles and who planned to undertake a frozen-thawed embryo transfer with the availability of high-quality embryos were recruited. From the day they began endometrial preparation for frozen-thawed embryo transfer through early pregnancy, participants were randomized (1:1) to receive oral pills containing either 10 mg of prednisone (n = 357) or a matching placebo (n = 358) once daily. The main result was a live birth, which is defined as the delivery of any number of neonates that were delivered at 28 weeks or more gestation and who were showing signs of life.

The key findings of this study were:

1. 714 (99.9%) of the 715 randomly assigned women (mean age: 32 years) had data on live birth outcomes, hence they were included in the main analysis.

2. In the prednisone group, live birth occurred in 37.8% of women (135 of 357) compared to 38.8% of women (139 of 358) in the placebo group.

3. In the prednisone group, the rate of biochemical pregnancy loss was 17.3%, compared to 9.9% in the placebo group.

4. Preterm births occurred in 5.5% of pregnancies in the placebo group and 11.8% of pregnancies in the prednisone group.

5. Rates of biochemical pregnancy, implantation, neonatal problems, congenital abnormalities, clinical pregnancy, other adverse events, and mean birthweights did not differ statistically significantly across groups.

In conclusion, prednisone usage may raise the risk of preterm birth and biochemical pregnancy loss, according to data. These findings call into question the efficacy of prednisone in treating recurrent implantation failure in clinical practice.

Reference:

Sun, Y., Cui, L., Lu, Y., Tan, J., Dong, X., Ni, T., Yan, J., Guan, Y., Hao, G., Liu, J.-Y., Zhang, B., Wei, D., Hong, Y., He, Y., Qi, J., Xu, B., Lu, J., Zhang, Q., Zhao, S., … Chen, Z. (2023). Prednisone vs Placebo and Live Birth in Patients With Recurrent Implantation Failure Undergoing In Vitro Fertilization. In JAMA (Vol. 329, Issue 17, p. 1460). American Medical Association (AMA). https://doi.org/10.1001/jama.2023.5302