Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting many women of reproductive age. Clomiphene is the first-line treatment for PCOS, but resistance to it is common. This study aims to evaluate the efficacy of dexamethasone combined with clomiphene in treating PCOS, providing a theoretical basis for clinical practice.
Methods
A comprehensive search was conducted across several databases, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Medical Network, and VIP Information Chinese Journal Service Platform (VIP), from their inception to January 2023. Meta-analysis was performed using Review Manager and Stata software. The risk of bias in the selected studies was assessed using Cochrane’s risk of bias tool, and publication bias was evaluated through funnel plots, Begg’s test, and Egger’s test.
Results
Twelve studies encompassing a total of 1270 PCOS patients were included. Compared to the control group, dexamethasone combined with clomiphene significantly improved pregnancy rates (RR = 1.71, P < 0.00001), ovulation rates (RR = 1.30, P < 0.00001), luteinizing hormone levels (SMD = -0.94, P < 0.00001), estradiol levels (SMD = 0.99, P = 0.05), progesterone levels (SMD = 5.08, P = 0.002), and testosterone levels (SMD = -1.59, P < 0.00001). No significant effects were observed on ovulation-stimulating hormone levels (SMD = 0.15, P = 0.37), adverse reactions (RR = 1.30, P = 0.30), dizziness (RR = 1.50, P = 0.45), and vomiting (RR = 1.67, P = 0.48).
Conclusion
Combining dexamethasone with clomiphene enhances ovulation and pregnancy rates in PCOS patients and improves hormonal profiles.
Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder among women of reproductive age, characterized by irregular secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), and significant insulin resistance. The etiology of PCOS is complex, involving genetic, environmental, and lifestyle factors, and remains controversial.
Clomiphene citrate is widely used to induce ovulation in PCOS patients. It works by blocking estrogen receptors in the hypothalamus, stimulating follicular development through a negative feedback mechanism. Dexamethasone, on the other hand, can inhibit aromatase activity and regulate estrogen levels, significantly increasing FSH levels.
Previous studies suggest that combining dexamethasone with clomiphene may improve pregnancy and ovulation outcomes in PCOS patients, but clear evidence is lacking. This study uses meta-analysis to systematically assess the efficacy and safety of this combined therapy.
Methods
Literature Search Strategy
Following Cochrane Handbook guidelines, a search was conducted across several databases from their inception to January 2023, using keywords like “Dexamethasone,” “Clomiphene,” and “Polycystic ovary syndrome.” Studies in languages other than Chinese and English were excluded.
Eligibility Criteria
The study included only randomized controlled trials (RCTs) that examined the effects of combining dexamethasone with clomiphene in PCOS patients. Excluded were animal studies, prospective studies, cohort studies, reviews, and other non-RCT literature.
Data Extraction
Two researchers independently extracted relevant data, including author names, publication year, geographic location, sample size, intervention and control treatments, and main outcomes. A third researcher verified the data for accuracy.
Quality Assessment
Using the Cochrane risk of bias assessment tool, two researchers independently evaluated the included studies. Discrepancies were resolved by a third researcher.
Statistical Analysis
Continuous variables were analyzed using standardized mean difference (SMD) and 95% confidence intervals (CIs), while dichotomous variables were analyzed using relative risk (RR) and 95% CIs. Heterogeneity was assessed with the I² statistic and χ² test, and publication bias was evaluated using Begg’s and Egger’s tests. Statistical analyses were conducted using Review Manager 5.3 and STATA 15.1, with a significance level set at P < 0.05.
Results
Literature Search Results
The initial search yielded 211 studies, reduced to 170 after deduplication. Screening titles and abstracts excluded 114 studies, leaving 20 for full-text review. Ultimately, 12 RCTs met the inclusion criteria.
Findings
Meta-analysis showed that combining dexamethasone with clomiphene significantly improved pregnancy and ovulation rates, as well as hormonal levels, compared to control treatments. However, no significant effects were observed on ovulation-stimulating hormone levels or the incidence of adverse reactions.
Conclusion
The combination of dexamethasone and clomiphene appears to be an effective treatment for improving ovulation and pregnancy rates in PCOS patients, as well as enhancing hormonal profiles, suggesting a promising approach for clinicians managing this condition.
