Tacrolimus in Fertility: A New Hope for Women Facing Repeated IVF Failures or Miscarriages

Have you tried multiple IVF cycles without success? Or gone through the heartbreak of repeated miscarriages despite doing everything right?

If yes, you may be wondering, “Is my immune system secretly affecting my chances of pregnancy?”

This is where a lesser-known medicine, Tacrolimus, might offer new hope.

Tacrolimus is a medication typically used to suppress the immune system in transplant patients. Recently, it’s being explored as a potential option for couples facing fertility challenges, especially those who have experienced recurrent implantation failure (RIF) or recurrent pregnancy loss (RPL).

However, using Tacrolimus for fertility is still not common practice and requires a thoughtful, case-by-case approach. Dr. Jay Mehta, a well-known fertility expert in India, emphasizes that Tacrolimus should only be considered after other treatment options have been explored.

Doctors may use Tacrolimus when a woman:

• Has gone through 2 or more failed IVF cycles, despite having good-quality embryos.
• Suffers from recurrent pregnancy loss without any clear reason.
• Shows signs of an overactive immune system that may be preventing implantation or causing miscarriages.

These are cases of “immune-related infertility”—a condition that’s still being researched but very real for many women.

According to Dr. Jay Mehta, Tacrolimus is not a standard treatment for infertility. It should only be used in specific situations where other potential causes for implantation failure have been ruled out. Due to the medication’s complexity and potential risks, careful consideration and close monitoring are essential.

Tacrolimus is usually taken in tablet form once or twice a day. In fertility treatments, low doses like 1–2 mg per day are used.

Doctors may start it:

• A few days before embryo transfer, or
• At the time of ovulation in natural cycles.

It’s often part of a customized immune protocol which may also include:

• Steroids (like prednisolone)
• Intralipid infusions
• Blood thinners (like heparin)

⚠️ This is not a routine medication—only used under specialist guidance.

While research is still growing, several case studies and small trials have shown positive results:

• Higher implantation rates
• More clinical pregnancies
• Fewer early miscarriages

Especially in women who had unexplained IVF failures with immune abnormalities.

But it’s important to know:
💬 “Tacrolimus is not a magic pill. It works best when the cause is clearly immune-related.”

Tacrolimus might be suitable for patients who meet the following criteria:

• Genetically Normal Embryo: The embryo has been tested and confirmed to be euploid (chromosomally normal).

• No Chronic Endometritis: The uterus is healthy and free of chronic inflammation, as confirmed by tests like biopsy or hysteroscopy.

• No Known Causes of Implantation Issues: Other common reasons for implantation failure or miscarriage have been ruled out.

• Healthy Pelvic Condition: No pelvic disorders like adenomyosis, endometriosis, fibroids, or polyps are present.

Tacrolimus should be given under the guidance of a transplant physician or nephrologist due to its immunosuppressive effects.

The usual dose is 1 mg per day, starting when endometrial preparation begins with hormone therapy. Treatment typically continues until cardiac activity is detected during early pregnancy. Regular monitoring is crucial to detect potential side effects, such as kidney issues or elevated blood sugar levels.

Even though low doses are used, Tacrolimus is still an immunosuppressant. That means it can lower your body’s ability to fight infections.

Possible side effects:

• Kidney problems
• High blood sugar
• Increased risk of infections 

That’s why regular blood tests are essential during treatment.

Good news: Many studies have not found any major birth defects linked to Tacrolimus. It has also been used safely in pregnant women with organ transplants

Important Considerations

• Tacrolimus should not be the first option in fertility treatments. It’s more of a last-resort choice after other methods have not been successful.

• Always involve healthcare professionals experienced with the drug, especially specialists in transplantation or nephrology.

• Be aware of the risks and ensure that close monitoring is in place throughout the treatment.

If you’ve had multiple failed embryo transfers or recurrent miscarriages with no clear cause—and your tests suggest an immune issue—Tacrolimus might be worth exploring.

But always consult with a fertility specialist or reproductive immunologist, Dr. Jay Mehta, before starting any immune treatment.

Fertility is already an emotional journey. When the immune system adds another layer of complexity, it can feel overwhelming. But with evolving science and medicines like Tacrolimus, there’s real hope.