March 26, 2021 5:35 pm

Nathalie Wiederkehr

Many women with infertility problems can be helped with targeted tests and treatments. Unfortunately, some women are left without a clear diagnosis. This means that there is no basis for a specific therapy, because if no specific problem can be identified, there is no real starting point for the doctors. It is hoped that, for example, implantation failure can be circumvented with general therapies or simply with IVF. However, it is often not possible to be certain that such therapies will benefit the patient. One such treatment is the administration of cortisone in the hope that it will facilitate implantation. In this article, you can find out what this therapy promises, what it actually does and what cortisone is.

What is cortisone?

You have probably heard of cortisone as a medicine. It is available in all forms and is used for therapy in almost every medical field. Cortisone is an inactive form of the endogenous hormone cortisol. After being absorbed into the bloodstream, cortisone is converted into the active hormone cortisol in the liver, where it can develop its effects. There is no longer just one type of cortisone, but several variants with different effects. The most common is called hydrocortisone.

Effect of cortisol in the body

Finally, cortisol has been produced in the body. The body also produces this hormone itself in the adrenal cortex. The adrenal glands are small endocrine organs located above the kidneys. In their function of producing hormones, they have little in common with the 'normal' kidneys.

Cortisol belongs to the group of glucocorticoids and is colloquially known as the stress hormone. Its main function is to keep blood sugar levels high enough in stressful situations, even when no sugar has been consumed with food. Cortisol mobilises sugar from the body's own reserves in the liver and muscles.

Cortisol also has an immunosuppressive effect. This means that the presence of cortisol down-regulates inflammatory reactions that are part of the immune response to pathogens or other substances. This property is used in pharmacology. Sometimes the body reacts unnecessarily strongly to a substance that is not a pathogen. This can lead to allergies. It can also happen that the immune system attacks the body's own structures. This is known as autoimmune disease. In both cases, the immune response is not really triggered and the overreaction makes the body sicker than it actually is.

Cortisone is therefore often the drug of choice for autoimmune diseases or allergies. Because it is a hormone produced naturally in the body after conversion to cortisol, or at least very similar to it, it is usually very well tolerated. It also works quickly and produces a marked improvement. Cortisone is often used for psoriasis, acne, sarcoidosis, gout, ulcerative colitis or Addison's disease, to name but a few.

Cortison

What are the arguments in favour?

The main argument for cortisone treatment before IVF is that it is well tolerated. Short-term doses of cortisone have few side effects and there is no evidence that the drug worsens implantation. It is given in the hope that the patient has a previously unrecognised autoimmune reaction against the embryo. While this is certainly possible, it does not apply to all women with implantation failure for unknown reasons. So the principle of 'nothing to lose' applies.

In addition, the administration of cortisone is not particularly costly. In contrast to many other treatments in reproductive medicine, this method offers a cheap and low-risk alternative. This is partly because the treatment is not as invasive as a laparoscopy. On the other hand, there is no need for extensive laboratory tests in addition to IVF.

Another reason for cortisone treatment is that cortisol levels may play a role in implantation. A 2002 study found that women who received hormone therapy before IVF had higher cortisol levels and a higher implantation rate. However, the role that hormone levels and the ratio of cortisone to cortisol actually play in the cycle and in implantation is not yet known. In addition, the study was not very large, with a total of 69 participants. A larger number of people would be needed to get generally valid results (https://pubmed.ncbi.nlm.nih.gov/12202432/).

What are the arguments against?

The only big argument against cortisone treatment before IVF is that the effectiveness of the method has not really been researched. The treatment is like a throwing contest, where people are blindfolded and asked to throw at stacks of cans. Sometimes they hit the cans, but most of the time they miss.

«The main argument for using cortisone before IVF is that it is well tolerated.»

Cortisone therapy in women with autoimmune diseases.

However, the situation is different when autoantibodies are found in the patient's blood. These are components of the immune system that are directed against the body's own structures. They often cause rejection reactions in the uterus, leading to implantation failure. In general, women with other autoimmune diseases such as type I diabetes, Hashimoto's disease, Graves' disease or Addison's disease should always be tested for such antibodies. Since the body has already failed to recognise faulty immune responses elsewhere, it is more likely to have failed to do so during implantation. In such cases, cortisone therapy in combination with IVF can make a big difference. It can suppress the misguided immune response and allow the egg to nestle peacefully in the lining of the womb.

As always, it is best to seek advice from a qualified doctor. A blood test is always a good idea, especially if you are wondering whether cortisone therapy is useful or even necessary. Even if no autoantibodies are found in your body, corticosteroid treatment may still be justified. It is well tolerated, has few side effects when used for a short time, does not require a lot of effort and you may be one of those cases where a blindfolded person will go through the whole stack of doses. So it's worth a try if it means you can fulfil your dream of having children.

About the Author

Hello, I am Nathalie Wiederkehr, a medical tourism expert from Biel, Switzerland. I too wanted to have children, but due to my age and divorce I was not supported in my country. That is why I founded "Your IVF Support" to help all women with my knowledge about fertility treatments in Europe.

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