Cycle scheduling with oral contraceptive pills in GnRH antagonist protocol vs long protocol: a randomized, controlled trial

Abstract

OBJECTIVE: To compare the flexible GnRH antagonist and the GnRH agonist long protocol in patients at high risk of OHSS undergoing IVF.DESIGN: Single-centre open label randomized prospective study. MATERIALS AND METHODS: The study included 144 women who had moderate or severe OHSS or had been at risk of OHSS during their first IVF/ICSI cycle with a mid-luteal long GnRH agonist plus gonadotrophin stimulation protocol. Patients were randomized to receive either cetrorelix 0.25 mg/day starting on day 3 of the menstrual cycle (antagonist group) or triptorelin 0.1 mg/day starting on day 21 of the menstrual cycle (agonist group). Ovarian stimulation was achieved with rFSH initiated on day 3 of the cycle at the maximal dose of 150 IU; the dose was adjusted depending on ovarian response. Embryo transfer was performed 2 or 3 days after oocyte retrieval. Luteal phase support was started on the day of oocyte retrieval using micronised progesterone vaginal gel.RESULTS: The two groups were similar in mean age, duration of infertility, body mass index, baseline FSH, total amount of rFSH administered and proportion of patients undergoing intracytoplasmic sperm injection. When oocyte maturation was triggered, the levels of E2 were lower in the antagonist group than in the agonist group (p<0.001). The number of cancelled cycles was significantly higher in the GnRH agonist group than in the GnRH antagonist group (9 versus 1, p¼0.022). The total number of oocytes retrieved, the number of metaphase II oocytes retrieved and the fertilization rate were similar in the two groups (p¼0.602, p¼0.621 and p¼0.946). Clinical pregnancy rate per initiated cycle was similar in the the two groups (p¼0.457); live birth rate per initiated cycle was 23.6% in the antagonist group and 26.4% in the agonist group (p¼0.700).CONCLUSION: When compared with the GnRH agonist protocol, the flexible GnRh antagonist protocol is associated with a similar pregnancy rate with a reduction in the number of cycles cancelled because of the risk of OHSS.O-93 Monday, OBJECTIVE: Recently, controversy has arisen regarding the use of oral contraceptive pill and the impact on implantation rates in patients undergoing IVF/ICSI. This debate is still open as cycle scheduling is a common practice in most units. Thus, we decided to compare cycle outome after scheduling with the standard long protocol versus the use of OCPs in patients undergoing GnRH antagonist cycles.DESIGN: Prospective, randomized, controlled trial. MATERIALS AND METHODS: Regular cycling women under 39 years, <3 previous IVF attempts were enrolled in this trial. Previous low response to COH, ovarian surgery or PCO were excluding factors. A total of 115 patients received OCP (0.030 EE/0.15 desogestrel) for 12 to 16 days, and COH was started on day 5 post-pill; similarly, 113 patients received long protocol from day 20-22 of the previous cycle. Patients were randomized at the time of cycle planning, according to a computerized random number list by a nurse coordinator.RESULTS: Groups were comparable in age (34.1...

Study of two strategies to induce follicular wave emergence for assisted reproductive treatments (ART)—a preliminary trial

“…Indeed, multivariate analysis found that women's age had no effect on the difference in follicle number before and after both interventions. Similarly, the shorter OC-free interval before starting OI in the control group is also probably of minimal clinical significance, because when the OC-free interval exceeds 4 days OI outcomes are similar to when OI is not preceded by OC use [28][29][30]. For the same reason, any difference in the proportion of women who used OC before OI was likely to have no effect on this study's outcomes.…”

Effects of oral contraceptive pretreatment on IVF outcomes in women following a GnRH agonist protocol

“…Speculatively, this difference might be due to the time needed for the recovery of pituitary and ovarian activity after oral contraceptive suspension (Klein and Mishell, 1977;van Heusden and Fauser, 1999), which leads to different endocrine profiles when ovarian stimulation is started with different protocols. It has also been suggested that endocrine profiles at the beginning of ovarian stimulation play an important role in cycle outcomes (Garcia-Velasco et al, 2011;Kolibianakis et al, 2004).…”

“…ral contraceptives are widely used in IVF-embryo transfer (IVF-ET) (Garcia-Velasco et al, 2011;Hauzman et al, 2013;Weisman et al, 1989). Oral contraceptives consisting of oestrogen and progesterone inhibit endogenous FSH and LH secretion through a negative feedback mechanism (Cohen and Katz, 1979) and thus suppress gonadal function and synchronize the follicle cohort (Cedrin-Durnerin et al, 2007;Gonen and Casper, 1990).…”

Early initiation of gonadotropin-releasing hormone antagonist in polycystic ovarian syndrome patients undergoing assisted reproduction: randomized controlled trial ISRCTN69937179

“…Other investigators reported no deleterious effects of pretreatment with OCP in PCOS patients undergoing IVF/ET [6,[8][9][10]40]. In a recent prospective randomized controlled trial, Garcia-Velasco et al [42] concluded that the use of OCP to schedule patients undergoing the antagonist protocol has no negative effects on pregnancy outcome. Our data is in agreement with the notion that pretreatment with OCP does not seem to have any deleterious effects on the outcome of IVF/ET in PCOS patients undergoing the antagonist protocol.…”