Low-dose dexamethasone augments the ovarian response to exogenous gonadotrophins leading to a reduction in cycle cancellation rate in a standard IVF programme.
BACKGROUND
Cancellation of assisted conception cycles because of poor ovarian response to gonadotrophins is a significant problem in assisted reproduction. Various adjuvant treatments have been suggested to improve responsiveness. This study reports on the potential benefits of low dose dexamethasone.


METHODS
Patients <40 years of age were invited to participate in a twin centre prospective double blind randomized placebo controlled study. A total of 290 patients were recruited and computer randomized using sealed envelopes to receive either 1 mg dexamethasone (n = 145) or placebo tablets (n = 145) in addition to a standard long protocol gonadotrophin-releasing hormone analogue with gonadotrophin stimulation regime.


RESULTS
A significantly lower cancellation rate for poor ovarian response was observed in the dexamethasone group compared with controls (2.8 versus 12.4% respectively, P < 0.002). Further comparisons between the dexamethasone group and controls were made of median fertilization rates (60 versus 61% respectively, NS), implantation rates (16.3 versus 11.6% respectively, NS) and pregnancy rate per cycle started (26.9 versus 17.2%, NS). The benefit was apparent in patients both with polycystic and normal ovaries.


CONCLUSIONS
Low dose dexamethasone co-treatment reduces the incidence of poor ovarian response. It may increase clinical pregnancy rates and should be considered for inclusion in stimulation regimes to optimize ovarian response.
Keay
S D
SD
University of Warwick, School of Biological Sciences, Gibbet Hill Road, Coventry CV4 7AL, UK. SKeay@bio.warwick.ac.uk
Lenton
E A
EA
Cooke
I D
ID
Hull
M G
MG
Jenkins
J M
JM
D000328:Adult; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006062:Gonadotropins / Q000627:therapeutic use*; D006801:Humans; D010053:Ovary / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011085:Polycystic Ovary Syndrome / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D016896:Treatment Outcome
D005938:Glucocorticoids; D006062:Gonadotropins; D003907:Dexamethasone