The ultrashort flare GnRH-agonist/GnRH-antagonist protocol enables cycle programming and may overcome the “detrimental effect” of the oral contraceptive

Orvieto, Raoul

doi:10.1016/j.fertnstert.2012.06.053

Cited by 2 publications

(2 citation statements)

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“…We completely agree with their comprehensive scholarly description and analysis of the published literature and with their detailed critique of the metanalysis by Griesinger et al (2010). Moreover, we believe that OC pretreatment has no detrimental effect on IVF outcome, but rather a beneficial effect, specifically when combined with the ultra-short flare GnRH-agonist/GnRHantagonist protocol (Orvieto, 2012;Orvieto and Laufer, 2014).…”

Section: To the Editorsupporting

confidence: 74%

To pill or not to pill in GnRH antagonist cycles: what should be the appropriate wash-out period?

Orvieto

2015

Reproductive BioMedicine Online

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Section: To the Editorsupporting

confidence: 74%

To pill or not to pill in GnRH antagonist cycles: what should be the appropriate wash-out period?

Orvieto

2015

Reproductive BioMedicine Online

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“…The latter could circumvent the alleged detrimental effect of the OCP pretreatment on endogenous LH levels, which in turn could impair oocyte competence or endometrial receptivity. This protocol has been used with success in poor responder patients [32]. However, no prospective studies have compared so far the efficacy of this combined approach to other stimulation protocols.…”

Section: Discussionmentioning

confidence: 99%

Cycle scheduling for in vitro fertilization with oral contraceptive pills versus oral estradiol valerate: a randomized, controlled trial

Hauzman

Zapata

Bermejo

et al. 2013

Reprod Biol Endocrinol

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BackgroundBoth oral contraceptive pills (OCPs) and estradiol (E2) valerate have been used to schedule gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles and, consequently, laboratory activities. However, there are no studies comparing treatment outcomes directly between these two pretreatment methods. This randomized controlled trial was aimed at finding differences in ongoing pregnancy rates between GnRH antagonist IVF cycles scheduled with OCPs or E2 valerate.MethodsBetween January and May 2012, one hundred consecutive patients (nonobese, regularly cycling women 18–38 years with normal day 3 hormone levels and <3 previous IVF/ICSI attempts) undergoing IVF with the GnRH antagonist protocol were randomized to either the OCP or E2 pretreatment arms, with no restrictions such as blocking or stratification. Authors involved in data collection and analysis were blinded to group assignment. Fifty patients received OCP (30 μg ethinyl E2/150 μg levonorgestrel) for 12–16 days from day 1 or 2, and stimulation was started 5 days after stopping OCP. Similarly, 50 patients received 4 mg/day oral E2 valerate from day 20 for 5–12 days, until the day before starting stimulation.ResultsPretreatment with OCP (mean±SD, 14.5±1.7 days) was significantly longer than with E2 (7.8±1.9 days). Stimulation and embryological characteristics were similar. Ongoing pregnancy rates (46.0% vs. 44.0%; risk difference, –2.0% [95% CI –21.2% to 17.3%]), as well as implantation (43.5% vs. 47.4%), clinical pregnancy (50.0% vs. 48.0%), clinical miscarriage (7.1% vs. 7.7%), and live birth (42.0% vs. 40.0%) rates were comparable between groups.ConclusionsThis is the first study to directly compare these two methods of cycle scheduling in GnRH antagonist cycles. Our results fail to show statistically significant differences in ongoing pregnancy rates between pretreatment with OCP and E2 for IVF with the GnRH antagonist protocol. Although the study is limited by its sample size, our results may contribute to a future meta-analysis. An interesting future direction would be to extend our study to women with decreased ovarian reserve, as these are the patients in whom an increase in oocyte yield—due to the hypothetical beneficial effect of steroid pretreatment on follicular synchronization—could more easily be demonstrated.Trial registrationClinicalTrials.gov http://NCT01501448.

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The ultrashort flare GnRH-agonist/GnRH-antagonist protocol enables cycle programming and may overcome the “detrimental effect” of the oral contraceptive

Cited by 2 publications

References 8 publications

To pill or not to pill in GnRH antagonist cycles: what should be the appropriate wash-out period?

To pill or not to pill in GnRH antagonist cycles: what should be the appropriate wash-out period?

Cycle scheduling for in vitro fertilization with oral contraceptive pills versus oral estradiol valerate: a randomized, controlled trial

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