Could glucocorticoids help embryo implantation?

This study analyzed the effects of glucocorticoids given during assisted reproductive treatments. Glucocorticoids were found to increase pregnancy rates in some women, but cannot be recommended for routine use.  

Glucocorticoids are steroid hormones with anti-inflammatory and immune suppressing effects. The use of glucocorticoids has been advocated to improve womb environment before embryo implantation. This review investigated whether the routine use of glucocorticoids around the time of implantation improved outcomes in women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles.

Fourteen randomized and controlled trials (involving 1879 couples) were included in this analysis. Participants included couples diagnosed with infertility from any cause. Outcomes of IVF or ICSI cycles were compared between women given glucocorticoids around the time of implantation, and those not receiving glucocorticoids.

Only three of the studies reported live birth rates, and these did not differ among women receiving glucocorticoids. Thirteen of the studies reported pregnancy rates. Pooled analysis of data also showed no evidence that routine use of glucocorticoids improved pregnancy rates. However, all studies showed a trend toward increased pregnancy rates (though not statistically significant). Among couples undergoing IVF rather than ICSI (a sub-analysis of 650 women in six trials) a significantly higher pregnancy rate was noted for women receiving glucocorticoids. However, pregnancy rates during IVF do not necessarily correspond with live birth rates.

The review of trials found no evidence that glucocorticoids helped to improve live birth rates. However, there was some evidence of increased pregnancy rates among women undergoing IVF (rather than ICSI). 

The findings of this analysis were limited to the routine non-selective use of glucocorticoids. Results can not be used to estimate effect in women with unexplained infertility, self-antibodies do to other medical conditions, or recurrent IVF failure. Further studies are required to clarify the possible role of this therapy among such women.