Effects of methylprednisolone therapy on pregnancy rates in women who has high level of antithyroid antibody on in vitro fertilization programme-a retrospective case-control study

Effects of methylprednisolone therapy on pregnancy rates in women who has high level of antithyroid antibody on in vitro fertilization programme-A retrospectivecase-control study.In recent studies, antithyroid antibody positivity is found to be related with low pregnancy rates in assisted reproductive therapy. Methylprednisolone treatment is adviced to reduce the local inflamation and achieve moderate immune tolerance for developing embryo. In some studies methylprednisolone, acetylsalicylic acid and tyroid hormone combination treatment is investigated. The aim of this study is to investigate the effect of only methylprednisolone therapy on pregnancy rate in women who are positive for antithyroid antibody and undergo in IVF-ET. In our study, patients who are under thyroid hormone therapy included as a subgroup.A retrospective, case-kontrol study. 158 patients whose antithyroid antibodies are above normal limits; anti-T > 64 U/ml and anti TPO > 57 U/ml were included and divided into three groups. Group 1: 16 mg/day methylprednisolonetreatment wasgiven from oocyte retrieval for 14 days and continued 21 days with 4 mg/day if there is a pregnancy (n=44), Group 2: continuous levotyroxin+16 mg/day methylprednisolone from oocyte retrieval to embryo transfere (3.7 days) was given as a subgroup (n=41), Group 3: 16 mg/day methylprednisolone treatment was given from oocyte retrieval to embryo transfer day (3.7days) as a control group (n=73).As a result of this study it is observed that; using methylprednisolone increased pregnancy rates from 32% to 43%, but this 11% was not statisticaly significant (p=0.20). Patients who use methylprednisolone only 3.7 days may conceive more than normal. In group 1 Anti T levels were decreased from 115,2 ± 121,5 to 86,85 ± 88,2, and statisticaly significant 26% decrease was observed (p=0,047)*.In group 3, from 214,3±380,6 to 251,1±444,3 statisticaly significant 14% increase was observed (p=0.027).Anti TPO levels decreased 18% from 658,9±1060,8,to 539,3±907,8 in group 1 (p=0.007). In group 3 136% increase from 313,3±682,1 to 741,6±1343,6 was found statisticaly significant(p=0.000).If pregnant patients? Anti TPO levels in group 1, compared with patients who aren?t conceived in group 3, a 82% significant decrease was observed. This finding suggests that using prednisolone for long time may increases pregnancy rates with decreasing Anti TPO levels.If pregnant patients? Anti TPO levels in group 1, compared with Anti T levels it is found to decreased 51.2%, more than patients who aren?t take prednisolone long time and aren?t conceived. This finding can be considered as a proof of decrease of Anti TPO levels is more helpful than decrease of Anti T levels.It seems that probable pregnancy induced immune mechanisms increase antithyroid antibody levels and these antibodies effect implantation. This study suggests that immunotherapy with only corticosteroids could improve the clinical pregnancy rates with reducing levels of autoantibody in patients whose antibody levels are high undergo IVF-ET.Key words: thyroid autoantibody, methylprednisolone, infertility, in vitro fertilization