Corticosteroids Prior to Embryo Transfer in Assisted Reproduction in Women with Crohn’s Disease and Ulcerative Colitis – A Nationwide Cohort Study

Abstract

Purpose

Former studies have suggested that women with Crohn’s disease (CD) and ulcerative colitis (UC) have a decreased chance of a live born child after assisted reproductive technology (ART) treatment. It is debated whether corticosteroids before ART may improve outcomes, either by decreasing inflammatory bowel disease-related inflammation or increasing endometrial receptivity. We examined the efficacy of corticosteroids before embryo transfer in women with CD and UC.

Patients and Methods

Our cohort study is based on nationwide Danish health registries, comprising women with CD and UC receiving an embryo transfer (1 January 2006 through 2017). Exposed cohorts constituted women with CD and UC who had received corticosteroids within three months before embryo transfer, and the unexposed cohorts women with CD and UC who did not receive corticosteroids. Our primary outcome was live birth. We controlled for multiple covariates in the analyses.

Results

We examined 2408 embryo transfers. In patients with CD, 114 embryo transfers were preceded by a corticosteroid prescription, and 964 were not. The corresponding numbers in UC were 122 and 1208, respectively. The adjusted odds ratio (aOR) for live birth in women with CD receiving corticosteroids before embryo transfer, relative to women with CD not receiving corticosteroids, was 0.89 (95% CI 0.49–1.63). The corresponding aOR in UC was 0.98 (95% CI 0.55–1.74).

Conclusion

Corticosteroids prior to ART in women with CD and UC did not increase the chance of a live born child. The exact impact of corticosteroids prior to embryo transfer in patients with CD and UC still remains to be determined.

Keywords:

• corticosteroids
• Crohn’s disease
• ulcerative colitis
• inflammatory bowel disease
• assisted reproductive technology
• ART
• assisted reproduction

Acknowledgment

The project was supported by the Augustinus Foundation, the Danish Colitis-Crohn patient organization, and Center for Clinical Epidemiology, Odense University Hospital. The funding sources had no role in the design, conduct, analysis or in the reporting of the study results.

Data Sharing Statement

According to Danish legislation, our own approvals to use these register data for the current study do not allow us to distribute or make patient data directly available to other parties. Any interested researchers may apply for access to data through an application to the Research Service at the Danish Health Data Authority ([email protected]). Also, access to data from the Danish Health Data Authority requires approval form the Danish Data Protection Agency. The authors of this paper do not have special access privileges to the data used in the current study.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

Bente Mertz Nørgård reports grants from the Augustinus Foundation and the Danish Colitis-Crohn patient organization, during the conduct of the study. The authors report no other conflicts of interest in this work.