Clomiphene citrate and dexamethazone in treatment of clomiphene citrate-resistant polycystic ovary syndrome: a prospective placebo-controlled study

Abstract

Induction of ovulation by adding DEX (high dose, short course) to CC in CC-resistant PCOS with normal DHEAS is associated with no adverse anti-estrogenic effect on the endometrium and higher ovulation and pregnancy rates in a significant number of patients. Induction with DEX appears to be independent on age, period of infertility, BMI or WHR.

Short‐term metformin treatment for clomiphene citrate–resistant women with polycystic ovary syndrome

“…It still remains unclear whether metformin improves ovulation by direct inhibition of androgen production or by improving insulin sensitivity, and thus indirectly lowering serum androgens. Elnashar et al [6] used high doses of dexamethazone in women with CC-resistant PCOS. Although they reported a significantly increase in ovulation rates, endometrial thickness, and pregnancy rates, no effect was observed on hyperandrogenism and hirsutism.…”

“…Furthermore, previous studies have shown that although ovulation rate is increased to 75%-80% during CC therapy, conception rate is increased to 30%-40% only [4]. For these unresponsive patients, before moving to gonadotropin therapy or laparoscopic ovarian drilling, some other adjuvant therapies have been previously reported such as bromocriptine (in the presence of hyperprolactinemia or galactorrhea), oral contraceptives (for pretreatment suppression of luteinizing hormone), pulsatile GnRH (to preserve physiological interactive feedback), tamoxifen [5], dexamethasone [6], and extended doses of CC [7]. Studies have shown that when insulin-sensitizing drugs such as metformin or triglitazone are used to decrease insulin secretion in women with PCOS, the rates of ovulation, whether spontaneous or in response to CC treatment, increase for these women [8][9][10][11].…”

Ovulation Induction Management of PCOS

“…This protocol was tested in a recent randomized trial involving women with CC-resistant PCOS who had normal concentrations of DHEAS. 40 Subjects were randomized to 2 groups. Women in both groups received CC 100 mg/d on cycle days 3 to 7, but those randomized to CC+ DEX also received DEX, 2 mg/d from cycle days 3 to 12, whereas the control group received placebo (folic acid tablets) on days 3 to 12.…”

Management strategies for ovulation induction in women with polycystic ovary syndrome and known clomifene citrate resistance

“…These encouraging preliminary results were then confirmed in a further RCT by Elnashar et al [88] on 40 clomifene citrate-resistant PCOS women with normal Treatment strategies for ovulation in infertile PCOS patients with clomifene citrate resistance Palomba et al 469 DHEAS treated with 100 mg clomifene citrate and randomized to dexamethasone or placebo. Compared with placebo, a higher ovulation and pregnancy rate (75 and 40%, respectively) was observed [88].…”