The aim of this work was to evaluate the efficacy of adding dexamethazone (DEX) (high dose,
short course) to clomiphene citrate (CC) in CC-resistant polycystic ovary syndrome (PCOS) with normal dehydroepiandrosterone
sulphate (DHEAS) in induction of ovulation. METHODS: Eighty infertile women with CC-resistant
PCOS were randomly assigned into two groups. Group I: Clomiphene citrate 100 mg/day was given from day 3 to
day 7 of the cycle and DEX 2 mg/day from day 3 to day 12 of the cycle. Group II: Same protocol of CC combined with
placebo (folic acid tablets) was given from day 3 to day 12 of the cycle. The main outcome was ovulation. Secondary
measures included number of follicles >18 mm endometrial thickness and pregnancy rate. Ovarian follicular
response was monitored by transvaginal ultrasound. HCG 10 000 U was given when at least one follicle measured 18
mm, and timed intercourse was advised. RESULTS: There were no statistically significant differences between
groups as regards age, duration of infertility, BMI, waist–hip ratio (WHR), menstrual pattern, hirsutism, serum
DHEAS or day of HCG administration. The mean number of follicles >18 mm at the time of HCG administration and
the mean endometrial thickness were significantly higher in the DEX group than in the placebo group (P < 0.05).
Similarly, there were significantly higher rates of ovulation (75 versus 15%) (P < 0.001) and pregnancy (40 versus
5%) (P < 0.05) in the DEX group. Dexamethazone was very well tolerated as no patients complained of any side
effect. There was a significant difference between the responders and non-responders in the presence of oligomenorrhea,
amenorrhea or hirsutism. CONCLUSION: 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.