Human Reproduction, Vol. 16, No. 9, 1861-1865,
September 2001
© 2001 European Society of Human Reproduction and Embryology
Low-dose dexamethasone augments the ovarian response to exogenous gonadotrophins leading to a reduction in cycle cancellation rate in a standard IVF programme
1 University of Warwick, School of Biological Sciences, Gibbet Hill Road, Coventry CV4 7AL, 2 University of Sheffield, Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield S3 7RE and 3 University of Bristol, Division of Obstetrics and Gynaecology, St Michael's Hospital, Southwell St, Bristol BS2 8EG, UK
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. CONCLUSION: 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.
Key words: dexamethasone co-treatment/gonadotrophins/IVF/ovarian stimulation/poor response
4 To whom correspondence should be addressed. E-mail: SKeay{at}bio.warwick.ac.uk
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