Corticosteroids for IVF

What are corticosteroids?

• Corticosteroids are a type of steroid hormone that occurs naturally in the body and are also manufactured for medical use.
• Common corticosteroid drugs used in Australia include prednisolone and dexamethasone.
• Corticosteroids are used to treat many medical conditions, including rheumatoid arthritis, gout, lupus and allergic reactions. In these conditions, they work by reducing inflammation and suppressing the immune response.
• Corticosteroids are also given to pregnant people who are at risk of pre-term birth. They can increase the chance of the baby surviving if they are born prematurely and can reduce the risk of them having health problems. However, the information on this website is about the use of corticosteroids in people having IVF - not people who are already pregnant and at risk of premature labour.

Why might corticosteroids improve IVF outcomes?

• The immune system plays an important role in embryo implantation and pregnancy.
• There are many different immune cells in the endometrium (lining of the uterus), including natural killer cells.
• It has been suggested that some people experiencing repeated implantation failure or repeated miscarriage may have higher levels or overactivity of immune cells, such as natural killer cells, than average. However, this has not been proven as the results of scientific studies have been mixed.
• Corticosteroids during IVF are thought to suppress the activity of the natural killer cells and other immune cells in the endometrium.
• Corticosteroids are approved for use in many conditions such as rheumatoid arthritis, inflammatory bowel disease, asthma, and eczema – they are not approved in Australia for use in the IVF setting. Prescribing corticosteroids with the goal of improving IVF outcomes is considered "off-label" use.

Why might corticosteroids not improve IVF outcomes?

• Most patients probably have a normal level of immune cells or immune activity in their endometrium
• Immune cells like natural killer cells are involved in the process to embryo implantation. It is important to have enough of these cells in the endometrium. As corticosteroids may reduce the levels of immune cells, they could make the chance of implantation lower. If immune cell levels are already low, using corticosteroids during IVF could make this problem worse. This means that, although it is possible that some patients may benefit from corticosteroids, other people who take them may have a reduced chance of getting pregnant.
• Studies show mixed results on whether immune cell levels affect pregnancy success rates
• Immune tests, such as tests to check levels of natural killer cells, have not been validated and it is not clear what levels of natural killer cells should be considered ‘high’ or ‘low’. More about immune testing here.
• Corticosteroids are sometimes considered for people experiencing repeated or recurrent implantation failure or miscarriage. It is important to remember that most embryo transfers don’t result in pregnancy, and miscarriage is common. Most of the time when embryos fail to implant or are miscarried, it is due to genetic or chromosomal problems in the embryo itself, rather than issues with the endometrial lining. Therefore, corticosteroids may not be expected to make much difference to the chance of successful implantation.

Who might consider corticosteroids for IVF?

People who have experienced one of the below issues

• Recurrent implantation failure
• Recurrent pregnancy loss
• High levels of Natural Killer Cells

Do corticosteroids for IVF work? What the evidence says

Corticosteroids, like prednisolone and dexamethasone, don’t seem to improve the chances of getting pregnant or having a baby through IVF. This appears to be true both for people who have repeated implantation failure and for those undergoing IVF in general. The evidence was judged as moderate quality as, although there are 11 trials, they were mostly small studies and therefore the overall result is imprecise.

Side effects of corticosteroids

Common side effects of prednisolone and dexamethasone include:

• Mood changes and excessive mood swings
• Anxiety
• Restlessness
• Nausea and vomiting
• Sleep disturbance
• Diarrhoea or constipation
• Increased or decreased appetite
• Weight gain or weight loss
• Headaches
• Dizziness
• Bloating and rounding of the face

Corticosteroids like prednisolone and dexamethasone are powerful drugs. The likelihood and severity of side effects increases with higher doses and longer-term use.

For more information:

• Patient information leaflet for prednisolone and dexamethasone
• For information about safety of medicines in pregnancy, search for the name of any medicine on the 'Best use of medicines in pregnancy (Bumps)' website:

Risks of corticosteroids in IVF and long-term outcomes

• Corticosteroids suppress the immune system. Because of this, there is a slight increase in infection risk despite the short courses used in IVF.
• Some studies have linked corticosteroid use in early pregnancy to a higher chance of having a baby with a cleft lip and/or palate. However, this is uncommon and the vast majority of babies exposed in the womb to systemic corticosteroids are born without these conditions.
• Corticosteroids can affect the body's ability to handle glucose. For diabetics, this means that your diabetes may become more severe.  For others, diabetes may develop for the first time while taking corticosteroids.
• Corticosteroids can reduce bone mineral density, increasing the risk of fractures (broken bones). This risk rises with higher doses and longer duration of treatment and is generally considered relevant for people who use corticosteroids for three months or more. The risk of bone fracture decreases after stopping the medication.
• Avascular necrosis of the hip occurs when prolonged high-dose corticosteroid use cuts off blood flow to the hip bone, leading to erosion and permanent damage. This is very rare.

Corticosteroid such as prednisolone has been used in Australia since 1990, and approximately 10,000 IVF cycles have used corticosteroids.

Cost of corticosteroids for IVF

Prednisolone and dexamethasone generally cost about $10 AUD for 30 pills. If they are taken for 12 weeks, then the cost is approximately $120 AUD.

Cost information is indicative only, costs can vary from clinic to clinic and depending on different circumstances.

Practical considerations about corticosteroids for IVF

• Corticosteroids are small pills or tablets usually taken 1-3 times a day.
• They may be started from the beginning of an IVF cycle, or around the time of embryo transfer.
• They may not be recommended in people with certain medical conditions, such as diabetes, peptic ulcer disease, and osteoporosis. It is important to tell your IVF specialist about all of your medical conditions and other medications being taken.
• Patients on high doses or who take this medication for a long time (e.g. 3 weeks or more) should not stop the medication abruptly, instead the medication should be slowly reduced over time. There are serious side effects if this is not followed correctly.

Unsure about some of the terms we have used? Use our glossary to understand scientific or unfamiliar terms.