Dexamethasone for poor ovarian response prior to IVF.
N.Petrogiannis¹, S.Zafiriou², Ch.katsetos*, K.Prionistis¹, A.Diamantis³.

1. Gynecology Dept of Navy Hospital Athens

2. Besançon, IVF Unit France

3. Cytopathology Dept of Navy Hospital Athens

*Royal Free Hospital, London, UK

   Introduction: Glucocorticoids have been suggested to be useful adjuncts to gonadotrophin stimulation prior to IVF), although it is unclear whether benefit us limited to patients with polocystic ovaries (PCO).  This study thus assessed the effect of dexamethasone (dex) contentment on ovarian response in patients with polycystic and ultrasonically normal ovaries.

   Materials and methods: A prospective, randomized, double blind, placebo-controlled study was conducted on a series of 96 IVF patients< 38 years old who consented to participation. Patients were randomized to receive 1 mg dex daily or placebo throughout gonadotrophin stimulation until the night prior to oocycle retrieval.

   Results: Patient characteristics were similar in the dex and placebo groups. Cycle cancellation due to poor ovarian response was significantly lower in the dex group than in the placebo group. With the numbers studied, no significant difference was seen in either pregnancy or embryo implantation rates, although these were higher in the dex group compared to the placebo: 27,8versus 16,9% and 15,2versus 11,1% respectively. No significant difference was seen in cancellation rates for over response (see table below).

Cancellation rate for poor ovarian response (%)

   Conclusions: Dexamethasone cotreatment with gonadotrophins may be useful for patients with both PCO and normal ovaries. Beyond suppression of hyperandogenism, potential mechanisms of action include direct effects via ovarian glucocorticold receptors, enhanced growth factor secretion, alterations in cytokine profiles and influences on ovarian cortisol metabolism of action, the clinical benefit of dex benefit in this study warrants further investigation.