Keay S D, Lenton E A, Cooke I D, Hull M G, Jenkins J M
University of Warwick, School of Biological Sciences, Gibbet Hill Road, Coventry CV4 7AL, UK.
Hum Reprod. 2001 Sep;16(9):1861-5. doi: 10.1093/humrep/16.9.1861.
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.
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.
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.
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.
由于卵巢对促性腺激素反应不良而取消辅助生殖周期是辅助生殖中的一个重大问题。已提出各种辅助治疗方法来提高反应性。本研究报告了低剂量地塞米松的潜在益处。
邀请年龄小于40岁的患者参加一项双中心前瞻性双盲随机安慰剂对照研究。共招募了290名患者，使用密封信封进行计算机随机分组，除了标准的长效促性腺激素释放激素类似物与促性腺激素刺激方案外，分别接受1毫克地塞米松（n = 145）或安慰剂片（n = 145）。
与对照组相比，地塞米松组因卵巢反应不良而取消的比率显著降低（分别为2.8%和12.4%，P < 0.002）。对地塞米松组和对照组的中位受精率（分别为60%和61%，无显著性差异）、着床率（分别为16.3%和11.6%，无显著性差异）以及每个开始周期的妊娠率（26.9%和17.2%，无显著性差异）进行了进一步比较。多囊卵巢和正常卵巢的患者均出现了这种益处。
低剂量地塞米松联合治疗可降低卵巢反应不良的发生率。它可能会提高临床妊娠率，应考虑将其纳入刺激方案以优化卵巢反应。
