The usefulness of corticoids in stimulated cycles for in vitro fertilization.

Abstract

1 Editorials in this journal do not necessarily reflect either the Editorial Board's or the publisher's opinion. z To whom correspondence should be addressed at Institute of Reproductive Endocrinology and in Vitro Fertilization, Trauttmansdorffgasse 3A, 1130 Vienna, Austria. spective randomized crossover trial that the combination of dexamethasone and clomiphene citrate produced significantly more pregnancies than clomiphene citrate alone when given to anovulatory or oligomenorrhoeic women. In these women DHEAS estimations were performed before the treatment and it could be seen that the improved ovulation and pregnancy rate with dexamethasone was restricted to those patients who had DHEA-S levels above 200 ixl/dl and was not seen in patients with DHEA-S levels below 200 ixl/dl. This supported the concept that the mechanism of action of dexamethasone was through adrenal suppression. In fact, there were reports that adrenal suppression with corticoids was explicitly successful in patients with hyperandrogenism (7) and with polycystic ovarian syndrome (PCO) (5). In 1970, Yen et al. (8) explained for the first time the ovulatory failure in PCO by an increased luteinizing hormone (LH) output of the pituitary gland which was the result of a positive feedback action caused by estrogens originating peripherally by conversion from adrenal androgens. In addition, Daly et al. proposed a direct detrimental effect of adrenal androgens on ovarian follicles (6). So far, adrenal suppression with corticoids seems indicated primarily in patients with signs of adrenal hyperandrogenism. However, most of the patients recruited for in vitro fertilization (IVF) do not have signs of hyperandrogenism, nor do they have cycle abnormalities. But many of them develop increased LH levels under stimulation therapy (9,10). This could be the result of the same mechanism which Yen et al. have described, except that the functional disturbance arises in a relatively shorter period of time. It is easily conceivable that any treatment for infertility--especially an IVF t reatment--can cause considerable stress for the patients, which may be the reason for an increased adrenal androgen output. In order to study the effect of adrenal suppression by corticoids on the results of IVF, we started a pilot study in 1984 whereby every treatment cycle for IVF was supplemented with prednisolone, 7.5