I am taking prednisone along with Clomiphene to induce ovulation. I never responded to Clomiphene until I took the prednisone. What does the prednisone do? What are the long-term effects? Does the combination increase the chance of miscarriage?

J.S.

Studies have shown that women who fail to ovulate and have high levels of the adrenal hormone DHEAS may have improved ovulation when steroids such as prednisone or dexamethasone are used in low doses. The risks of short-term low-dose steroid use is quite low. The most common side effect is water retention or stomach irritation.

While this approach may improve the ovulation rate, I do not recommend the use of steroids for women with polycystic ovary syndrome (PCOS). Women with this condition frequently demonstrate insulin resistance, meaning that it takes more insulin to keep their blood sugars in the normal range. This excess insulin stimulates increased production of male hormones by the ovary and results in irregular menses and ovulation problems. By interfering with insulin action, steroid hormones could actually worsen the hyperinsulinemia seen with PCOS and make that condition worse. I recommend the addition of a low-dose steroid only in those situations where DHEAS is elevated and PCOS is not part of the picture.