Researcher Calls for End to Common Empirical Treatment

From a meta-analysis of 13 studies, researchers are concluding that a commonly prescribed therapy should not continue to be used in the current manner. The treatment, prescribing glucocorticoids such as prednisone in hopes of assuring embryo implantation, is empirical as opposed to evidence-based. Therein lies both the reason and the quandary. After reviewing all of the studies, which involved a total of 1,759 couples in randomized controlled trials that compared success rates of IVF and IVF with ICSI, the review authors concluded that there simply is not enough evidence of benefit to using prednisone. Plus, there are possible ill effects for developing embryos that could be unwittingly exposed to the steroid hormones. However, much of fertility treatment has evolved from the empirical use of different therapies. There's nearly always a cost-benefit ratio analysis involved. "Empirical treatment" refers to therapies that are attempted before a diagnosis is confirmed. Doctors are often in a position to prescribe empirically when there are acceptable reasons -- such as the ethics-based inability to experiment on a population, like embryos, or in cases where the patient will be harmed strictly because of any delay in administering treatment. On the other hand, evidence-based medicine uses a scientifically-proven framework within which to determine appropriate treatment. The reviewers of the glucocorticoid studies are simply saying that the common prescribing of this class of steroid hormones, like prednisone, has not been well-proven to be beneficial enough, even though the potential adverse effects also have not been well documented. Patients and their doctors are still in charge of their treatment plan of choice. For many women who either miscarry frequently in the first trimester or who have unexplained failed IVF cycles, the use of prednisone will likely continue until more solid evidence of contraindication is made available. For more details on the review, read this Health Behavior News Service article.

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