Oral contraceptive pill, progestogen or estrogen pre-treatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques

Abstract

Background For many subfertile women, assisted reproductive techniques (ART) is the only hope for a pregnancy and live birth. The combined oral contraceptive pill (OCP) given prior to the hormone therapy in an IVF cycle may result in better pregnancy outcomes of ART. Objectives To assess whether pre-treatment with combined OCPs, progestogens or estrogens in ovarian stimulation protocols affects outcomes in subfertile couples undergoing ART. Search methods We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO. Other electronic resources on the Internet, reference list of relevant articles were also searched as well as the ESHRE abstracts (2008). All these searches were conducted in November 2008. Selection criteria Randomised controlled trials of pre-treatment with combined OCP, progestogen or estrogen in subfertile women undergoing IVF/ ICSI. Data collection and analysis Two authors independently extracted the data and assessed risk of bias. We calculated Peto odds ratios for dichotomous data and weighted mean difference for continuous variables. Authors of trials were contacted in case of missing data. 1 Oral contraceptive pill, progestogen or estrogen pre-treatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques (Review)

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

“…A meta-analysis showed in GnRH agonist cycles that progestin pretreatment was associated with higher clinical pregnancy rate than placebo or no pretreatment (Smulders et al, 2010). Our results showed that progestin-induced menses was associated with higher levels of estradiol and LH and comparable endometrial thickness on the day of hCG trigger than spontaneous menses.…”

“…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). Frozen embryo transfer (FET) has been increasingly used and an elective freeze-all strategy has recently been advocated (Shapiro et al, 2014;Weinerman and Mainigi, 2014).…”

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

“…In contrast, a Cochrane review evaluating the use of oral contraceptives in ovarian stimulation protocols reported lower clinical pregnancy rates, a longer duration of stimulation, and higher gonadotropin consumption with OCP pretreatment in GnRH antagonist cycles. However, the authors acknowledged that most of the studies included in the review were small and of poor quality [28]. A meta-analysis of 6 randomized controlled trials also reported significantly lower ongoing pregnancy rates in GnRH antagonist cycles utilizing OCP pretreatment compared with antagonist cycles without pretreatment (-5% difference) [22].…”

Controlled Ovarian Stimulation in IVF Cycles

“…33 OK kullanılan grupta elde edilen oosit sayısı ise daha yüksek bulunmuştur. 34 Bu veriler OK'ların GnRH antagonistleriyle olumsuz etkileşimi olduğunu göstermektedir. OK eklenmesiyle gebelik oranlarındaki düşmenin nedeni ise net değildir.…”