S/P and steroids
9 Replies
4everhopeful - October 12

Dear Dr Smith :)

My latest FSH result came back at 9.5 on day 3 of my cycle :( so new RE has decided to put me on the short protocol this time, using suprefact and puregon at 300iu (which is the max dose at my new clinic, though I've heard patients of other clinics who are perscribed higher doses of this particular drug. But my clinic says if it doen't work at 300iu, it won't work any more effectively at a higher dose :-\).

Additionally she has put me on dexamethasone 1mg a day to improve egg quality... In your experience does taking steroids help with the quality of the eggs?

They also want me to take 75mg of aspirin a day. I know it thins the blood somehow, but what other benefits will it have on my tx?

I also have to take dexamethasone during the 2 week wait, in addition to 3 cyclogest, to hopefully ward of the early bleeding I experienced in my previous cycles.

I've had to take the pill for the last 3 weeks because naturally my lining didn't shed properly, and there was still 6mm left on day 3 of menstruation ???

I was wondering what could cause this, could it have anything to do with my FSH and ovarian reserve? My periods seem really quite light these days, and I'm worried my hormones are beginning to fail me :(

Would a 9.5 FSH reading on day 3, have been any lower on day 2?

Many, many thanks for your help :)

Nat :)

 

Dr Smith - October 12

I am not aware of any studies that show dexamethasone improves egg quality. I'm not sure where they came up with that idea.

I'm sorry, but your other questions are of a medical nature and Dr. Jacob (a Reproductive Endocrinologist) can answer them better than I. Please post these questions on Dr Jacob's Infertility 101 Message Board.

 

4everhopeful - October 20

Thank you anyway Dr Smith :)

My new clinic has a big research facility attached, and they say that low does steroids can improve egg quality :) I just wondered what your thoughts were on the use of steroids during stims :)
My friend (who has FSH over 10) had steroids in her last cycle and is now pregnant ;D so I'm hoping they'll make the difference for me too, seeing as last cycle my egg quality was poor :-\

Many thanks,
Nat :)

 

Dr Smith - October 21

I checked again with the National Center for Biotechnology Information and couldn't find any scientific publication or report demonstrating an association between steroids and egg quality. So, if your new clinic is promoting the use of steroids to improve egg quality, their research must be in the very early stages. I look forward to reading the published study.

Meanwhile, please be aware that there is a long history of unsubstantiated claims in this field of medicine. Because clinics are competing for your business, there is a temptation to promote the "uniqueness" of that particular clinic in their approach to IVF. More often than not, in their haste to get your business, unsubstatiated claims and promising preliminary research results are used as a marketing device. Buyer beware.

Best of luck.

 

4everhopeful - October 21

Thank-you for the warning Dr Smith!

Fortunately, we were already at the clinic when steroids were mentioned as part of my treatment:) and so far they seem far more competent and caring than my last one, fingers crossed!
The new RE said she just wanted to do everything in her power to help us get a positive result :), and thought steroids would help me, after getting a poor batch of eggs last cycle.
I am dissapointed though that there isn't anything published yet about it's usage in IVF :-\


The new RE has also recommended we have laser assisted hatching this cycle, which will be done on day 2 at the 4 cell stage. Any thoughts? Is blastocyst AH more beneficial than doing it on day 2?

Many thanks,

Nat :)

 

Dr Smith - October 21

The jury is still out as to the efficacy of assisted hatching on Day 2-3 of development or at the blastocyst stage. Some groups have reported improved pregnancy rates following AH in couples with repeated IVF failure, when the protein coat is unusually thick, for frozen-thawed embryos and in women over 35 years of age. Other groups have found no beneficial effect of AH in any group. My own experience has been that AH didn't make much of a difference when performed on Day2-3, but didn't have any bad effect either. On the other hand, we have seen a 9% increase in implantation rate from 21% to 29% per embryo transferred (which is a significant improvement) following AH at the blastocyst stage. It has been suggested that the additional 2-3 days in vitro may cause more hardening of the protein coat and that is why myself and others have noted an increase in implantation rate following AH of blastocyst stage embryos.

The steroid story sounds interesting. Perhaps you can touch base with us again with more details about the treatment and the resulting egg quality.

 

4everhopeful - October 22

Thank you so much for your prompt answer Dr Smith :)

It seems then that AH is most beneficial when embryo's reach the blastocyst stage, and unfortunately my new clinic no longer offers blastocyst transfer, and always perform embryo transfer on day 2 :-\ They have a new laser assisted hatching machine at the clinic now, and RE says pregnancy rates have greatly improved since it's arrival at the clinic, almost 1/2 success rate so far...


My friend (who at 33 has blocked tubes and FSH over 10), didn't respond to stims on the l/p at all, and only produced cysts on both attempts on the l/p.
On the s/p she managed to get 7 eggs of average/poor quality, and 10 days after e/t her period arrived.
On her second s/p cycle, none of 9 eggs fertilized with standard IVF :-\
But on her 5th cycle of IVF (with ICSI) she took 1mg of dexamethasone daily, alongside stims, got 11 good quality eggs, and is now 3 months pregnant! So I'm wondering if it was the steroids that made the difference :-\

I will keep you posted how my tx goes with the steroids, and will let you know if they make a difference to the egg quality this time round :) I hope so!! I'm pinning all my hopes on third time lucky ;D

Many thanks,
Nat :)

 

4everhopeful - October 23

Dr Smith,

I found this link about dexamethasone and IVF, and thought you might be interested to read its findings:

http://humrep.oxfordjou
rnals.org/cgi/content/abstract/16/9/1861

With warmest regards,
Nat :)

 

Dr Smith - October 24

Thanks. I've seen this paper. Although the "poor responding" patients that received dexamethasone had a lower cancellation rate (meaning they exceeded 4 follicles/stim more often than the control group and were therefore allowed to continue to egg retrieval), the fertilization rate, implantation rate and pregnancy rate (all indicators of egg quality) were not significantly improved in the dexamethasone group. In this study, dexamethasone did not improve egg quality. Perhaps a follow-up study will show differently.

 

4everhopeful - October 25

Thank you for your reply Dr Smith :)

I had wondered what cancellation rate meant :-\ The paper did though seem to be "selling" the benefits of steroids in it's conclusions, so I'm really interested to read your thoughts on this :) I hope a follow up study will show differently to! Would be great if a drug could be found to enhance egg quality and pregnancy rates :)
Many thanks,
Nat :)

 

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