In-vitro fertilisation (IVF) treatments might cause acne.
IVF is an arduous journey, after stimulation of the ovaries to grow with days of hormone injection, the eggs are retrieved and fertilised to form embryos, which grows into blastocysts. Upon implantation, hormone supplementation is commonly prescribed to optimise the womb lining to support early pregnancy if it occurs. The progression may arrest at any stage and for most, it usually takes several cycles of stimulation to eventually get pregnant.
Apart from the immense psychological stress that can worsen the skin condition, biochemical changes also contribute to break outs in IVF. Acne is a common condition faced by women undergoing infertility treatments.
The surge of hormones can result in several side effects like mood swings, breast tenderness, hot flushes, headache, greasy hair and water retention. Be warned – Acne is a common problem faced by women undergoing in-vitro fertilisation.
Causes of acne during in-vitro fertilisation (IVF)
In standard IVF protocols, 4 types of fertility drugs may be given
- GnRH analogues – Lupron/Ganirelix
- GnRH controls ovulation before an infertility procedure. This is known to exacerbate acne and causes increased sebum production of the skin and scalp.
- Progesterone – Progesterone is used to support the endometrium and maintain early pregnancy in infertility treatment.
In acne that breaks out prior to menses, a major contributing factor would be a rise in progesterone from mid cycle. Progesterone causing increased oil production and simultaneously swell of the skin leading to clogged pores. Hence for patients who has history of breakout prior to menses will be at higher risk of exacerbation during IVF treatment.
- Gonadotropins – FSH/LH
Gonadotrophins is used to develop multiple egg follicles in the ovaries prior to egg extraction. Gonadotropins can potentially cause acne, but it is not a common side effect.
- Human Chorionic Gonadotropin (hCG) – hCG acts directly on the ovaries to cause the release of eggs from the ovarian follicle in IVF treatment.
hCG hormone produced by the placenta in early pregnancy. The surge of this hormone is the cause of breakouts in the first trimester through similar mechanism of causing increased oil secretion and swelling the skin.
Treatment of acne during in-vitro fertilisation (IVF)
There are very limited studies that study the impact of acne treatments on the IVF success rates. The process of subfertility treatment can be very prolonged and be extended to post-pregnancy. To leave acne untreated can negatively impact on one’s psychosocial status and leave permanent scars.
Home care is extremely important in preventing clogged pores.
- Cleanse your skin regularly twice a day
- Remove make up and concealers thoroughly
- Use moisturisers and sunblock that are non-comedogenic
- Exfoliate your skin twice a week
DO NOT pick on the pimple.
There are some all-natural home remedies proposed to combat acne. However, studies to prove its efficacy are lacking. They are mostly edible substances like apple cider vinegar, baking soda, citurs products, honey, turmeric, coconut oil etc. These home remedies are not likely to affect the body system and chances of conception. However, I would advise against treatments that involve caustic or acidic substance like apple cider vinegar and baking soda as they can cause irritation and potentially burn the skin causing post-inflammatory hyperpigmentation, which can persist beyond pregnancy.
Best treatments for acne during in-vitro fertilisation (IVF)
In the treatment of mild to moderate acne, topical antibiotics should first be the first-line treatment. This include clindamycin and erythromycin creams, which are well-studied to be safe for pregnancy. Benzoyl peroxide is a classified as Category C medication (small theoretical risk of harm to the fetus but most experts agree on its safety during use). However, it is very effective in controlling acne and is commonly used in combination to antibiotic cream in the treatment of acne in pregnancy.
Chemical peels like salicylic acid and azelaic acid has bacteriostatic properties and shows benefit in controlling acne breakouts by its keratolytic and comedolytic properties. Although salicylic acid has rarely shown systemic toxicity when applied to injured skin with over absorption, it has been deemed safe when used with a limited scope for short periods of time.
Narrow band phototherapy has anti-inflammatory properties which is effective in the treatment of acne and have good evidence to support its safety in pregnancy. However a decrease in serum folate is associated with long-term treatment. Folic acid is especially important in early pregnancy development and should be avoided in patients undergoing IVF.
Pulsed-dye and other lasers generally have shallow depth of penetration. Therefore, conceptually poses little risk to the fetus. There is no demonstrated risk noted till date and generally deem safe.
Of the Oral antibiotic medications, beta-lactams (penicillin and cephalosporins) are very effective in the treatment of acne and is classified as Category B drug, deem safe for pregnancy.
Acne treatments generally not recommended
When it comes to taking oral medication which enters the body system, most will be reluctant to proceed. In this section, we discuss the potential use of oral medications reserved for the most severe cases of acne that are resistant to safer treatments.
Oral retinoid medications is known for be teratogenic (affecting the development of organs of the baby) and some research have extrapolated this caution to the use of topical retinoid and adapalene (differin) as Vitamin A is known to be lipophilic and can be absorbed via the skin into the body. Despite the minute amounts that are absorbed, experts generally advice on complete avoidance during pregnancy and in women preparing to conceive in both the topical and oral form (Category X).
Oral antibiotics like tetracyclines, trimethoprim, and fluoroquinolones are generally avoided due to associated risks of miscarriage and bone discolouration. Oral metronidazole is extremely safe for pregnancy but may not be as effective as other antibiotics in the treatment of acne.
Oral prednisolone is related to cases of cleft palate. This is reserved for patients with the most severe cases of acne conglobate that is refractory to multiple modalities. Prescription of corticosteroids should be discussed with the respective obstetrician.
Spironolactone, an anti-androgenic medication, is sometimes used to treat hormonal acne in adults. This modulates the ‘male’ hormones. Therefore, it is contraindicated in pregnancy due to the risk of feminisation of the male fetus. Likewise, contraceptive pills – with female hormones, that we sometimes use to treat adult acne, are not used for the same reason. IVF patients should not be given these medications should pregnancy result from a successful pregnancy.
Even with the best treatments available and combination treatments, there is no quick solution to fix all your problems instantly. It usually takes 2-3 months for the results to show.
Seek treatment early
The best way to fight the negative feelings about acne is to get it treated. Not only does it help to manage your emotions, it also prevents bad scarring from cystic acne typical in hormonal acne.
Take care of yourself
Taking care of your whole body, de-stress and make time for activities that relaxes you can help with acne. Unknowing stress related habitual behaviours like picking on the pimple makes acne worse.
Regular exfoliation and using non-comedogenic skin care products prevent clogged pores. Hormones is a known cause for worsening pigmentation in patients who are on oral contraceptive pills, pregnancy and menopause. Exogenous hormones during IVF increases melanin production! The use of sunblock in during this time is extremely important to prevent pigmentations and darkening of pimple marks.
Talk to people
There are many side effects of in-vitro fertilisation (IVF). Acne during IVF is more common than you think! You are not alone. It will help to share your experiences and get support from people who are suffering or have suffered from the same condition.