Prednisolone – the fertility wonder drug?

When it comes to fertility medication, some are more controversial than others. A steroid called Prednisolone, marketed as Prednisone in a few countries, 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 that is sometimes prescribed to women with recurrent miscarriage and/or elevated natural killer (NK) cells. It’s also given to men to reduce the production of anti-sperm antibodies (which, like NK cells, may not be as scary as they sound). Prednisolone is basically a synthetic hormone that helps suppress immune responses.

Prednisolone isn’t just prescribed to fertility patients. Its anti-inflammatory and immuno-suppressive abilities can treat a range of other conditions, including allergies, blood disorders, respiratory problems and skin problems.

But while Prednisolone is well regarded in general medicine, the jury is out on its benefits to fertility patients. Lord Winston, for example, is distinctly wary of it. We’ve seen a few studies of Prednisolone’s alleged role in reducing the risk of miscarriage and the ‘threat’ from natural killer cells (cells that may attack the fetus). But most are small-scale. As yet, no extensive trials have been conducted.

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.

And a 2014 update of a Cochrane Review into immunotherapy for recurrent miscarriage had to exclude a number of studies into Prednisolone from analysis. They didn’t meet the exacting standards required.

When prescribed to female fertility patients, Prednisolone is used for a relatively short period of time. Doses vary, but 5 mg a day is common. Be wary if your clinic increases that daily dose, especially if it goes above 20 mg. Prednisolone pills are normally started on egg retrieval day. But patients with elevated NK levels, or a pattern of implantation failure after fertility treatments, may be put on the drug when they start their stimulating medication. That’s around two weeks earlier.

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 12 weeks pregnant. Your dosage may be gradually reduced.

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. We can only hope the claimed benefits are worth that risk.

Deciding whether or not to try a fertility drug like Prednisolone is not easy. On the one hand, there’s hope it could be your miracle cure. On the other, it may be a dead end. Unlike intralipid infusion therapy (another NK-cell treatment with limited evidence it really works) Prednisolone is at least quite cheap. It doesn’t feel like an expensive extra hoisted on you by a cash-hungry clinic.

If you’ve been recommended Prednisolone, give it careful thought. Talk to your GP and clinic. Make sure you’re fully aware of what’s involved and the implications for and against the treatment. The success stories on the fertility forums may sound enticing. But there’s no guarantee it will work for you. And until a large-scale, randomised, controlled trial is carried out, the situation remains unclear.