# do low dose steroids help implantation especially re autoimmune diseases



## mick1

Hi all,looking for your help/ feedback on this issue. I have suffered with arthritis since I was 15 I have also been unable to conceive and over the years have had various treatments including 3x IUI 3x IVF 1x FET I am now 45 and often wondered whether my infertility is linked to having arthritis and in fact only found out in last 5years that taking anti inflammatory drugs can seriously reduce ovulation and I've been taking these the last 30 years! I am now very near the top of an eggdonor list abroad and expecting treatment shortly but have seen some information over the months whilst I've been waiting that low dose steroids can help implantation for people suffering autoimmune diseases like mine,unfortunately the clinic I am with does not offer or encourage this treatment as I presume it is inconclusive,  however I do see other clinics believe in it.(and had I seen this info earlier I would have chosen a clinic that supports this treatment) I have looked on the net for more info but I don't seem to be able to find too much out about it.My arthritis consultant prob would prescribe the drugs but he would only do so under instruction from fertility clinic I think, and fertility clinic I am with if they allowed me to take these extra drugs they might not know correct doseage.I suppose I would really like to know  is there anything to loose by insisting I get these drugs cos I know if treatment fails I will believe that to be the reason,but if theres any way it would hamper my chances I wouldn't take them. And how would I find out the correct doses etc. I would welcome your comments.Many Thanks


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## coconutkym

i am casting around trying to find this answer to this too, also using donor eggs from abrod. 

george ndukwe ar care nottingham and argc london are uk leaders for this approach.  (nottingham weaiting times over 2 months) .

i would recomend reading dr beers book is yr body baby friendly as this gives all sorts of info about this

i understand form that book that  yr arthritis like my thyroid problem is caused  by an auto immune rweponse, as yr body sees things as a foreign body, and that response can extend to an embie. steroids dampen down that response, but heparin to prevent clotting can help too, 

U can get GP to do some antibody tests see list on ivetsigations and immunologyu thread on staring opuit board

othe drugs which can help are metformin (if u have pcos) vaigra if u have womb thickens spronblems, anti depressants can hep bllod flo in the right area too.

best wishes 
coco


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## three_stars

Just to say that you should probably avoid anti-depressants while TTC.  I know from my own experience (particularly effexor) as it raises your prolactin levels, thus making it less likely to concieve.  Viagra is for blood flow more then for lining thickeness... not necessarily the same thing ...although I have even tried this on last cycle for my very thin lining.  You should have had a doppler scan to determine if the blood flow is ok.  This treatment has been more useful( it seems) for those that have bad blood flows or a lining that has never been thick rather then in my case where it went bad following a D and C.  I only took 5 days and maybe not enough but saw no difference from thickness of last cycle.
As far as steriods it seems it is more and more common that most clinic do give steroids. ( IMO) it is more likely to do good then not so it is worth a try. 
Besides the estradiol ( 6 mg) I take 4 mg medrol per day and 1 tablet trental ( some people take 80 mg baby aspirin but some studies show trental is better... perhaps later if you are PG as I believe it has less effect on the baby)  I am no Dr. so just repeating my own experiences and research here!  
Also I do Clexane/ Lovenox 4.4 ml injections ( anticoagulant) from ET day forward.  
ANd I Take 8-10 days if possible of antibiotic/ doxcycline or Vibramycine for example 100 mg 2 x day .  Take until one day before ET for you and before Sperm sample for your DH.  In my case I keep having some bacterial infections but even when none were found it was done as a precaution. 
4 x 200 mg Progesterone was started day of EC or at least three days before ET.
This is more or less my DE program the past several cycles.... not that has worked yet but have been having lining problems.  

Of course it is not unusual that everyone has slightly different protocols and with your past arthritis problems, hopefully you find someone on the FF that has had same problem and can compare notes with you as well.  
Generally I do not advocate doing any self treatment without letting your clinic know and discussing with them.  I have often presented my own research and notes and then discussed with the DR abroad to make a decision together. 

Not sure what clinic you are going to but personally I find it way too long to be waiting for a donor at your age.  I  hope you or given a donor very soon.  There are plenty of clinics abroad so if you do not feel confident about the protocol or treatment they are giving don't hesitate to enroll elsewhere, again IMHO.  It certainly does not hurt to have other professional opinions.
Good luck.  
b123


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## mick1

Thanks for your info ladies, I suppose it would be most helpful if someone out there has some experience of an autoimmune disease where treatment has only been successful when treated with steriods, I believe lupus is reasonably similar  to arthritis and I found some research that steroids are recommended in those cases. I have considered emailing  Reprofit as the dr there seems very helpful and asking their medical opinon re steroids as I know they use them, but wonder whether this would this be right or whether they wouldnt comment  as I am not with them and now my donor is so close I wont be changing clinics.Decisions, decisions they dont get any easier! I seem to have trouble thinking clearly when ever its to do with my infertility/treatment!


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## earthe kitt

Hi - I have lupus/mixed connective tissue disease.
I had 12 cycles 10 using own eggs and 2 donor - the 2nd donor cycle was succesful using steroids and aspirin (plus hormones etc) so I would swear by them - mind you, it could be just chance and may have happened without steroids - who knows

Jo


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## hobiegirl

Hi,
The only time I got pregnant(then m/c) was when I took prednisolone 25mg.I have NK cells and high ANA's.
I went to a clinic in the USA and I did a Intralipids infusion too prior to EC.
This has been shown to be as effective as IVig but less scary as it is only fatty acids diluted in saline solution.Very new still though.
I saw Mr ******* about immune issues and he prescribes the Prednisolone and will also now prescribe Clexane as it seems I have Thrombophilia probs too now but he often suggests these anyway for immune issues.If you want to get an appt ring his secretary Cheryl on 02084019928.You can get an appt very quickly.
Hope this helps.......


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## mick1

Hi thanks for info ladies, I have an appt with my arthritis cons on 16th so will see wot he says about prescribing prednisolone as I definetly want to take it, I musnt leave any stone unturned as this is my last chance I've promised my dh that I will give up my dream of being a mother after this attempt and get on with our lives(as unfortunately this quest has ruined the last 14years or more). My donor has now been found and treatment is end of aug so fingers crossed. Does anyone know when you start taking prednisilone? and whether you should take heparin/clexane?


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## vixen1

Hi Mick - My Grandmother suffers from severe rheumatoid arthrits and I was told before my treatment that this was a likely indication that i would need immune drugs. I also had a pseudo rheumatoid nodule removed from my leg when I was 5 and have Endometriosis so my immune system seems well and truly messed up! 
I've had 5 failed treatments in the past and at the age of 24 I knew there must be more to it than bad luck. Sure enough, the first round of treatment with immune drugs worked. I took: 10mg Dexamethasone from around day 5 of stims until egg collection then 10 mg prednisolone thereafter (which I still take). I also take 60 mg Clexane, Metformin and Gestone. To be perfectly honest I'm not sure exactly what each drug is used to treat in my case, but I do know that a combination clearly worked for me!
I agree with Hobbiegirl, I know a few people who've had their cycles supported by immune treatment from Mr ******* and I would certainly reccommend it (IMO).

Good luck with everything! xxxx


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## mick1

Hi vixen1 and hobiegirl,
Where is mr shahata based? does he help you and prescribe even if you are under another clinic ie abroad?
Thanks mick1 x


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## vixen1

Hiya, I think Hobiegirl will know more about it than me I'm afraid, I've just heard what others have told me. I believe is based in London and he will treat you if your cycle is with another clinic, in fact that's what's so good about him (and I would have probably used him myself if I'd known about him sooner as I live so far from London where my new clinic is).

I think it's definitely worth giving them a call...


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## babycrazy

Hi Mike1
I was treated at Repromeda a different clinic than Reprofit in Brno Czech Rep.  I was given 0.5mg Dex steroid, for i beleive my sligtly raised male hormone Testosterone and my slightly underactive  Thyroid problem. I got PG , 1st IVF, at age 51.
The waiting list for donors at my clinic is very short, but the cost is eu1200 + more than Reprofit, but still over half the cost of Spanish Clinics .
Have you had test for blood clotting factors or Lupus?? these can also cause IF.

Xx
Karen


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## crusoe

Mr ******* is based at the miscarriage clinic on Harley Street London. He does work with anyone regardless of the clinic they are with.
He is a very nice man - but be warned he is expensive.

Crusoe
xx


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## mick1

Hi, yes thanks I rang Mr *******'s secretary and found out he's in london and that its £225.00! for just a consultation, wish I had known about him  a while back I'm sure he is worth the money as I've never had any 'immune tests' as such but now gonna stick with plan that arthritis con will prescribe prednisolone for me,its just the little details I need to find out, like when should you start taking it and why is it mostly teamed up with heparin/clexane?
Thanks
Mick1


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## coconutkym

there is thread about immune investigations on starting out. see london lou's list of tests to ask for. after 3rd failure incl with DE. i have found out from using this list and having tests that i have at least 2 immune problems, see specialist today dr armstrong at portland hopsital for steroids and heparin( i hope!!)

gp did most of tests on this list for free?

bets wishes

coco


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## hobiegirl

Hi Mick,
I don't know if you know that Mr ******* can be seen at Epsom hospital(be warned it is a maternity clinic!)Ashtead Hospiatl, Parkside in Wimbledon and there may be somewhere else too that I have missed.
I saw him recently again as I had a thrombophilia report which was really bad from the USA and he re-tested me and found I was normal.Despite that he wants me to be on Clexane 40mg next time and I am waiting to find out why...maybe it helps with immune issue...I don't know!
He is a very nice man but yes expensive!
Good luck!


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## Betty M

Hi Mick

I have quite severe lupus (sle).  I have had 3 fresh cycles - 2 successful, 1 not and 1 FET - successful but m/c. I took low dose aspirin on the second of the successful cycles and on the FET and on the unsuccessful one. My OB started me on aspirin at 8 weeks in the first successful cycle. I took no steroids or heparin in any cycle.  I also stopped all NSAIDs before and during treatment (anecdotally a friend with arthritis and one failed IVF stopped NSAIDs and then conceived naturally). I am however taking a powerful immunosupressant commonly used to prevent rejection of transplants so that may have had the same effect as steroids. 

I don't know how much read across there is between sle and RA but your rheumatologist ought to have some idea. My lupus clinic is one of the biggest and most experienced in the country and the consultants there assure me that infertility rates are roughly the same as in the general population and issues arise for lupus patients more in keeping pregnancies particularly for the sub-group of patients who also have APS/hughes syndrome. One of the diagnostic tests for APS is the lupus anti-coagulant test - this is often referred to on the boards as "lupus" it is not the same as lupus the disease which is rather confusing.  

Definitely worth having the usual recurrent m/c panel done plus any other immune type tests you want as that will at least rule out certain problems and give you additional treatment options.

Best wishes
Betty


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## coconutkym

mr armstrong at portland hosptal in london will see u quickly. consulatation cost £175. he will treat anyone (i am having TX in spain) he prescribes steroids and heparin, even IVIG too

best wishes

coco


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## babycrazy

Hi Girls
I see Lesly Regan at St Mary,s many years ago.
She prescribed aspirin to me before conception, as blood clotting can affect implantation also. I think 8 weeks into PG  would be far to late.
Ms Regan also advised back then test before and when you did conceive.  The reason being some women do not develop problems until PG,  ie clear in non PG state , but pos when Pg.
I know this info could be years out of date ,if so I apologise.
Xx
Karen


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