Effect of an oral contraceptive pill on follicular development in IVF/ICSI patients receiving a GnRH antagonist: a randomized study

Abstract

This randomized controlled study compared the effectiveness of a gonadotrophin releasing hormone (GnRH) antagonist protocol with or without oral contraceptive (OC) pretreatment on the number of oocytes retrieved in IVF or intracytoplasmic sperm injection (ICSI) patients. Sixty-four patients were randomized to start recombinant human FSH (r-hFSH) on day 2 or 3 after OC withdrawal (OC group) or on day 2 of a natural cycle (control group). From stimulation day 6 onwards, all patients were treated with daily (0.5 mg/ml) GnRH antagonist (Antide). OC pretreatment resulted in significantly lower starting concentrations of FSH, LH and oestradiol (P < 0.001) and a thinner endometrium (P < 0.0001). In the early stimulation period, fewer large follicles were found after OC pretreatment, leading to a significantly extended stimulation period (11.6 versus 8.7 days, P < 0.0001) with more follicles on the day of recombinant human chorionic gonadotrophin administration (15.4 versus 12.5, P = 0.02) and more oocytes retrieved (13.5 versus 10.2, P < 0.001) as compared with the control group. GnRH antagonist regimen, pretreated with OC, prevented the early endogenous FSH rise and improved follicular homogeneity, resulting in more oocytes. As a consequence of the extended treatment period, more rhFSH was required.

The effect of oral contraceptive pill for cycle scheduling prior to GnRH-antagonist protocol on IVF cycle parameters and pregnancy outcome

“…There is limited body of data in the literature on the use OCP pretreatment prior to GnRH antagonist protocol including three prospective randomized studies [8][9][10]. However, these studies focus only on the young IVF population and include relatively small numbers of patients and cycles.…”

“…To overcome this limitation in the GnRH antagonist protocol, patients can be offered the use of pretreatment with oral contraceptive pills (OCP) [4][5][6][7]. Moreover, a previous study has shown that OCP pretreatment before GnRH antagonist led to higher numbers of oocytes retrieved compared to the standard GnRH antagonist protocol [8]. On the other hand, longer stimulation periods and increased consumption of recombinant FSH (rFSH) were needed for stimulation [8][9][10].…”

“…Moreover, a previous study has shown that OCP pretreatment before GnRH antagonist led to higher numbers of oocytes retrieved compared to the standard GnRH antagonist protocol [8]. On the other hand, longer stimulation periods and increased consumption of recombinant FSH (rFSH) were needed for stimulation [8][9][10].…”

Effect of pretreatment with oral contraceptives and progestins on IVF outcomes in women with polycystic ovary syndrome

“…However, the effects of OCs or progestins pretreatment on outcome of IVF cycle remain inconclusive (Smulders et al, 2010), especially in PCOS which was often an exclusion criterion in many previous randomized trials investigating such effects (Cedrin-Durnerin et al, 2007;Huirne et al, 2006;Kolibianakis et al, 2006;Rombauts et al, 2006). OCs used for cycle scheduling in women with regular menses were suggested to have a remnant adverse effect on outcomes after fresh embryo transfer (Griesinger et al, 2010;Smulders et al, 2010).…”

Profound Pituitary Suppression Following Oral Contraceptive Pretreatment in Gonadotropin-releasing Hormone Antagonist Cycles Does Not Impact Outcome: A Retrospective Cohort Study

“…Interestingly, a retrospective study of women with polycystic ovary syndrome (vs. normal controls) undergoing IVF treatment also found that the use of successive OCP (≥3 months) improved serum hormone levels, antral follicle counts, and implantation and pregnancy rates [12]. The use of OCP pretreatment has also been associated with a reduction in endometrial thickness compared with no pretreatment, possibly due to the sustained suppression of luteinizing hormone (LH) and estradiol at the start of stimulation [13,14]. Although several studies have suggested a positive association between pregnancy rate and greater endometrial thickness on the day of ovulation trigger, up to a maximum of 12 to 14 mm [15], a reduced endometrial thickness at the start of the cycle may be beneficial in some patients to avoid overly thick endometrium following ovarian stimulation with human menopausal gonadotropin (hMG) [16].…”