Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Effect of Dexamethasone on ovarian response in infertile women aged over 35 years undergoing IVF/ICSI program

Authors
Mahnaz Ashrafi 1
Fatemeh Zafarani 2
Ensieh Sh.Tehrani 3
Monir Owj 3
Ahmad Reza Baghestani 4
Elham Amirchaghmaghi 3
1 Department of Endocrinology and Female Infertility, Royan Institute, Tehran, Iran; Department of Obstetrics and Gynecology, Shahid Akbarabadi Hospital, Faculty of Medicine, Iran university of Medical Sciences, Tehran, Iran
2 Department of Endocrinology and Female Infertility, Royan Institute, Tehran, Iran; Royan Research Center, Endocrinology & Infertility Department, Tehran, Iran
3 Royan Research Center, Endocrinology & Infertility Department, Tehran, Iran
4 Department of Epidemiology and Reproductive Health, Reproductive Medicine Research Center, Rouyan Institute, ACECR, Tehran, Iran
Abstract
Introduction: Poor ovarian response to exogenous gonadotrophins occurres in 9-26% of ART cycles. Ovarian reserve decreases by ovarian aging which is an important factor in decreasing ovarian response to gonadotrophins but there are other probable methods which are reported as affecting factors on ovarian response to gonadotrophins such as high dose of gonadotrophins, adjuvant therapy with growth hormone and glucocorticoids. In this study, we aimed to evaluate the role of Dexamethasone, as an effective factor on ovarian response, in infertile women aged over 35 years who referred to Royan institute. Material and methods: In this clinical trial, 72 infertile women, aged over 35 years, who referred to Royan institute to undergo IVF/ICSI program, were selected. Patient were divided into two groups in each group, 36 patients were studied. Laboratory tests including serum FSH, LH, Total Testosterone, Estradiol, Prolactin and thyroid function tests were performed on third day of menstrual cycle. Standard long protocol began on 21st day of menstrual cycle. Simultaneously, in triple blind method, each woman received either 2 tablets containing Dexamethasone or placebo. After 2 weeks, ovarian stimulation was started using 3 HMG ampoules from 2nd day of menstrual cycles and its dose was increased according to ovarian response. If the size of at least three follicles was more than 18 mm, HCG (10000 IU) was administrated after Estradiol measurement. After 36-38 hours of HCG administration, oocyte was retrieved by transvaginal sonography guidance. Embryo transfer was done after 48 hours. SPSS version 11.5 was used for data entry and results were analyzed by Paired t test and Chi-square. P v
Keywords
Assisted Reproductive Techniques
dexamethasone
gonadotropin
Ovarian response
Placebo
Keay S.D., Liversedge N.H., Mathur R.S., Jenkins J.M. Assisted conception foll-owing poor ovarian response to gonadotro-phin stimulation. Br J Obstet Gynaecol. 1997;104:521–527.
Mahutte N.G., Arici A. Poor responders: does the protocol make a difference? Curr Opin Obstet Gynecol.2002;14(3):275-81.
Keay S.D., Liversedge N.H., Jenkins J. M. Could ovarian infection impair the ovar-ian response to gonadotrophin stimulation. Br J. Obstet Gynaecol.1998;105:252–254.
Beckers N.G.M., Macklon N.S., Eijke-mans M.J.C., Fauser B.C.J.M. Women with regular menstrual cycles and a poor respo-nse to ovarian hyperstimulation for in vitro fertilization exhibit follicular phase charact- eristics suggestive of ovarian aging. Fertil Steril.2002;78:291-297.
Van Hooff M.H., Alberda A.T., Huisman G.J., Zeilmaker G.H., Leeventuveld R.A. Doubling the human menopausal gonado-trophin dose in the course of an in vitro fertilization treatment cycle in low respond-ers: a randomized study .Hum Reprod.1993; 8:369-373.
Karande V., Jones G., Veeck L., Muasher S. High dose follicule stimulating hormone stimulation at the onset of menstrual cycle does not improve the in vitro fertilization outcome in low responder patients. Fertil Steril.1990;53:486-489.
Adashi E., Rohan R. Intraovarian regula-tion. Peptidergic signaling systems. Trends Endocrinol Metab.1993;3:243-248.
Tarlatzis B.C., Zepiridis L.,Grimbizis G., Bontis J. Clinical management of low ovari-an response to stimulation for IVF: a syste-matic review. Hum Reprod Update.2003;9 (1):61-76.
Miell J.P., Taylor A.M., Jones J., Holly J.M., Gaillard R.C., Pralong F.P., Ross R.J., Blum W.F. The effects of dexamethasone treatment on immunoreactive and bioactive insulin-like growth factors (IGFs) and IGF-binding proteins in normal male volunteers. J. Endocrinol.1993;136(3):525-533.
Smith M.P., Mathur R.S., Keay S.D., Hall L., Hull M.G., Jenkins J.M. Preovu-latory human oocytes, cumulus cells and ovarian leukocytes express type 1 but not type 2 11- beta- hydroxysteroid dehydroge-nase (11 ?-HSD) RNA. Fertil Steril.2000; 73:825-830.
Lok I.H., Yip S.K., Cheung L.P., Yin Leung P.H., Haines C.J. Adjuvant low- dose aspirin therapy in poor responders undergo-ing in vitro fertilization:a prospective, rand-omized, double blind, placebo-controlled trial. Fertil steril. 2004;81(3): 556-61.
Keay S.D., Lenton E.A., Cooke I.D., Hull M.G.R., Jenkins J.M. Low-dose Dexa-methasone augments the ovarian response to exogenous gonadotrophins leading to a reduction in cycle cancellation rate in a standard IVF programme. Hum Reprod. 2001;16(9):1861-1865.
Gates G.S., Bayer S., Seibel M., Poretsky L., Flier J.S., Moses A.C. Characterization of insulin-like growth factor binding to human granulosa cells obtained during in vitro fertili-zation. J Recept Res.1987;7(6):885-902.
Homburg R., Ostergaard H. Clinical applications of growth hormone for ovarian stimulation. Hum Reprod Update.1995;1: 264-275.
Battaglia C., Salvatori M., Maxia N., Petraglia F., Facchinetti F., Volpe A. Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients. Hum Reprod.1999;14(7):1690-1697.
Kim C.H., Chae H.D., Chang Y.S. Pyridostigmine cotreatment for controlled ovarian hyperstimulation in low responders undergoing in vitro fertilization-embryo transfer. Fertil Steril.1999;71:652-657.
Casanueva F.F., Burguera B., Muruais C., Dieguez C. Acute administration of glucocorticoids: a new and peculiar stimu-lus to growth hormone secretion in man. J Clin Endocrinol Metab.1990;70: 234-237.
Zhou J., Bondy C. Anatomy of the human ovarian insulin-like growth factor system. Biol Reprod.1993;48:467-482.
Jenkins J.M., Gadd S.C., Anthony F.W., et al .Corticosteroids may act via IGF-1 to improve the response to ovarian stimulation in IVF poor responders. Br J Obstet Gynaecol.1994;101:269-270.
Isaacs J.D., Lincoln S.R., Cowan B.D. Extended clomiphene citrate (CC) and prednisone for the treatment of chronic anovulation resistant to CC alone. Fertil Steril.1997;67:641-643.
Kemeter P., Feichtinger W. Prednisolo-ne supplementation to Clomid and/or gona-dotrophin stimulation for in-vitro fertiliza-tion-a prospective randomized trial. Hum Reprod.1986;1:441-444.
Keay S.D. Poor ovarian response to gonadotropin stimulation the role of adju-vant treatment. Hum Fertil (Camb). 2002;5 (1 Suppl):S46-52.
Fridstrom M., Carlstrom K., Sjoblom P., Torbjorn H. Effect of prednisolone on serum and follicular fluid androgen concen-trations in women with polycystic ovarian syndrome undergoing in-vitro fertilization. Hum Reprod.1999;14(6): 1440-1444.
Keay S.D., Harlow C.R., Wood P.J., Jenkins J.M., Cahill D.J. Higher cortisol: cortisone ratios in the preovulatory follicle of completely unstimulated IVF cycles indicate oocytes with increased pregnancy potential. Hum Reprod.2002;17(9): 2410-2414.
Harlow C.R., Jenkins J.M., Winston R.M.L. Increased follicular fluid total and free cortisol levels during the luteinizing hormone surge. Fertil Steril.1997;68:48-53.
Adashi E.Y., Resnick C.E., D'Ercole A.J., Svoboda M.E., Van Wyk J.J. Insulin-like growth factors as intraovarian regulators of granulosa cell growth and function. Endo-crinol Rev.1985;6(3):400-420.
Journal of Reproduction & Infertility
Volume 5, Issue 4
Autumn 2004
Pages 308-314