Dexamethasone Improves Outcomes for Patients Undergoing In Vitro Fertilization

Dexamethasone has shown both efficacy and safety in suppressing progesterone secretion, making the ovary receptive to gonadotropin stimulation and improving the live-birth rate in infertile women, according to a study published in Clinical Endocrinology.

This randomized controlled trial included 459 infertile women who were undergoing a first-time cycle of in vitro fertilization/intracytoplasmic sperm injection. These participants were randomly assigned to either dexamethasone (n=230) or a non-treatment control group (n=299) in a 1:1 ratio.

The dexamethasone group showed significantly lower doses than the control group of both gonadotropins (1987±536 IU vs 2135±701 IU; P =.009, respectively) and progesterone serum levels on human chorionic gonadotropin day (3.1±1.4 nmol/L vs 4.0±1.3 nmol/L; P <.001, respectively).  

The days of stimulation in cycles was significantly lower in the dexamethasone group than the control group (9.91±1.52 days vs 10.66±2.14 days; P <.001, respectively). The 2 groups showed similar numbers in terms of pregnancy rates, 2 pronuclear embryos, and oocytes. The dexamethasone group also had a significantly greater live-birth rate (in 1 ovulation cycle) of 70.0%, vs 61.1% among controls (P =.029; 95% CI, 1.01-2.19).

Participants in the treatment arm received a daily dose of 0.75 mg of oral dexamethasone. The total live-birth rate per cycle was the primary outcome of this study, defined as a completion of fresh and frozen transfer cycles in 2 years following egg collection that resulted in a live birth. Secondary outcomes included total dose of gonadotropin, the length of stimulation, progesterone serum levels on human chorionic gonadotropin day, and the clinical and biochemical rates of pregnancy and miscarriage during the fresh-transfer cycles.

The study researchers conclude that “[progesterone] secretion can be suppressed by dexamethasone, and dexamethasone may sensitize the ovary to gonadotropin stimulation in [in vitro fertilization] treatment. In addition, the cumulative live‐birth rate was significantly higher in the [dexamethasone] group than in controls, and the obstetric and neonatal outcomes support the safety of [dexamethasone] treatment in [in vitro fertilization].”

Reference

Liu S, Shi L, Wang T, Shi J. Effect of low‐dose dexamethasone on patients with elevated early follicular phase progesterone level and pregnancy outcomes in IVF‐ET treatment: A randomized controlled clinical trial [published online July 27, 2018]. Clin Endocrinol (Oxf). doi: 10.1111/cen.13824