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 ovar ian response to gonadotrophins is a significant problem in assisted reprodu ction. Various adjuvant treatments have been suggested to improve responsiv eness. This study reports on the potential benefits of low dose dexamethaso ne. METHODS: Patients <40 years of age were invited to participate in a twi n centre prospective double blind randomized placebo controlled study. A to tal of 290 patients were recruited and computer randomized using sealed env elopes to receive either I mg dexamethasone (n = 145) or placebo tablets (n = 145) in addition to a standard long protocol gonadotrophin-releasing hor mone analogue with gonadotrophin stimulation regime. RESULTS: A significant ly lower cancellation rate for poor ovarian response was observed in the de xamethasone 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), i mplantation rates (16.3 versus 11.6% respectively, NS) and pregnancy rate p er cycle started (26.9 versus 17.2%, NS). The benefit was apparent in patie nts both with polycystic and normal ovaries. CONCLUSION: Low dose dexametha sone co-treatment reduces the incidence of poor ovarian response. It may in crease clinical pregnancy rates and should be considered for inclusion in s timulation regimes to optimize ovarian response.