Evaluating Dexamethasone as an Adjuvant in the Antagonist Protocol in PCOS Patients Undergoing IVF/ICSI: A Randomized Controlled Trial.

BACKGROUND

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, often requiring assisted reproductive technologies such as in vitro fertilization (IVF). Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication in PCOS patients undergoing IVF. Dexamethasone, a synthetic glucocorticoid, may improve IVF outcomes by reducing inflammation and optimizing ovarian stimulation. Polycystic ovarian syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age, often requiring assisted reproductive technologies such as in vitro fertilization (IVF). Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complications in PCOS patients undergoing IVF. This study evaluated the effect of dexamethasone in the gonadotropin-releasing hormone (GnRH) antagonist protocol for patients with PCOS undergoing IVF/ICSI.

METHODS

In this randomized, single-blind trial, 189 infertile PCOS patients were randomly assigned to either the dexamethasone group or the control group. The dexamethasone group received 0.5 mg orally twice daily, along with gonadotropins. The control group received gonadotropin alone. Primary outcomes included mature oocytes (metaphase II), follicle to oocyte index (FOI), clinical pregnancy and live birth rates. Secondary outcomes included gonadotropin dose, oocytes retrieved, embryo quality, and OHSS incidence.

RESULTS

Compared to the control group, the dexamethasone group showed significant improvements, including a higher number of mature oocytes (15.47 vs. 13.84, p < 0.001) and FOI (75.10 vs. 69.65, p = 0.045). Additionally, the dexamethasone group had a higher clinical pregnancy rate (43.8% vs. 22.6%, p = 0.002) and live birth rate (34.4% vs. 9.7%, p < 0.001), as well as an increased number of top-quality embryos (6.63 vs. 6.45, p < 0.001). No significant differences were observed in gonadotropin dose and OHSS incidence.

CONCLUSIONS

Dexamethasone significantly improved IVF outcomes in PCOS patients, including oocyte quality and pregnancy rates.