First intention IVF protocol for polycystic ovaries: does oral contraceptive pill pretreatment influence COH outcome?

Abstract

BackgroundMorphological aspect of polycystic ovaries (PCO) is a very common finding in an IVF center population: this includes PCOS patients identified in 18–25% of the couples presenting with infertility and so called “sonographic PCO only” the prevalence of which has been estimated as high as 33% in asymptomatic patients. Finding the optimal first intention IVF protocol for polycystic ovaries patients is still challenging in order to improve the controlled ovarian hyperstimulation (COH) outcome while avoiding ovarian hyperstimulation syndrome (OHSS). It has been suggested that women with PCO would benefit from a longer period of pituitary down-regulation. The purpose of this study was to compare an extended duration of OCP pretreatment with a classic GnRH agonist protocol.MethodsA single center prospective non-randomized study was performed from January 2009 to December 2010 in the Lille University Hospital including 113 women diagnosed with PCO(S) according to the Rotterdam ultrasonographic criteria and undergoing their first IVF attempt. Comprehensive hormonal and ultra-sonographic assessments were collected during COH in these patients. LH and androgen suppression and dynamics of follicular growth were compared between the two protocols as well as the COH outcome in terms of oocyte/embryo number and quality, implantation and pregnancy rates.ResultsNo significant difference was observed between the two groups concerning dynamics of follicular growth and hormonal values. Clinical and ongoing pregnancy rates were significantly lower in the OCP group despite same oocyte and embryo quality. Nevertheless, the cumulative pregnancy rate did not differ between the two groups. The incidence of OHSS was not statistically significant.ConclusionsExtended duration of OCP pretreatment, as a first intention IVF protocol for PCO patients, does not improve the pattern of follicular growth nor the oocyte and embryo quality.

Effect of pretreatment oral contraceptives on fresh and cumulative live birth in vitro fertilization outcomes in ovulatory women

“…In addition to lower fLBR that was associated with pretreatment OC, cLBR was also negatively affected. The impaired fLBR is consistent with previous studies (7,19,20), although the underlying mechanism remains unclear. Some have suggested that OC may induce an advanced endometrium maturation (21).…”

“…In a recent meta-analysis by Farquhar et al that included six studies, OC pretreatment was associated with a lower ongoing pregnancy rate/LBR after a fresh embryo transfer (0.74, 95% confidence interval 0.58À0.95) than that of nonpretreatment in GnRH-ant cycles (1). Limited data have been reported in PCOS women regarding (19).…”

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

“…Similar to the patients in this study with the long protocol, a previous randomized controlled trial showed that oral contraceptive pretreatment could prevent ovarian cyst formation without affecting ovarian response or clinical pregnancy rates (Biljan et al, 1998). However, another prospective nonrandomized study including 113 women with PCOS undergoing the GnRHa long protocol showed that oral contraceptive pretreatment was associated with lower clinical and ongoing pregnancy rates (Decanter et al, 2013). It could be speculated that this difference is explained by the different ovarian physiological situations and endocrine profiles of the patients included in these studies.…”

Is polycystic ovarian morphology related to a poor oocyte quality after controlled ovarian hyperstimulation for intracytoplasmic sperm injection? Results from a prospective, comparative study

“…We intentionally chose the sole PCOM criteria to establish our study group because it is now well recognized that there is no difference in the IVF outcome between PCOM-only and PCOS (3,13,14,31,32). Nowadays there is an almost universal consensus on the choice of follicular excess as the main criteria to define PCOM.…”