Optimal Candidates to Do Fresh Embryo Transfer in Those Using Oral Contraceptive Pretreatment in IVF Cycles

Abstract

ObjectiveConcern regarding the adverse impact of pretreatment of oral contraceptives (OC) prior to ovarian stimulation for in vitro fertilization (IVF) on pregnancy outcome has been debated. We investigated factors that may be associated with live birth rate (LBR) in fresh embryo transfer cycles after OC pretreatment.MethodsA retrospective study was conducted at the Reproductive Center of Ren Ji Hospital, Shanghai, China. 814 women aged 20–35 years undergoing their first autologous IVF cycle and fresh embryo transfer after OC pretreatment were included. Long gonadotropin releasing hormone (GnRH) agonist (a) or GnRH antagonist (ant) protocol was used for ovarian stimulation. Predictive factors for LBR were identified using multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis demonstrated that using GnRH-ant protocol for ovarian stimulation was associated with significantly lower LBR (OR 0.70, 95% CI 0.52–0.93), while endometrial thickness on day of hCG trigger was associated with increased LBR (OR 1.16, 95% CI 1.06–1.27). Despite comparable patients’ age, duration of infertility, BMI and basal FSH between GnRH-a and GnRH-ant groups, those using GnRH-ant resulted in significantly lower LBR compared to the GnRH-a group (37.4 vs. 48.5%, p = 0.002). Using ROC analysis and a cut-off endometrial thickness of < and ≥ 9.5 mm, those < 9.5 mm using GnRH-ant resulted in significantly lower LBR (28.5 vs. 43.4%, p = 0.004), while no differences were noted with an endometrial thickness ≥9.5 mm (49.6 vs. 51.1%, p = 0.78).ConclusionsLive birth was significantly impacted in OC pre-treated GnRH-ant cycles with an endometrial thickness of <9.5 mm on day of hCG trigger. Cryopreservation of all embryos in these cycles should be considered.

Follicular fluid lipidomic profiling reveals potential biomarkers of polycystic ovary syndrome: A pilot study

“…Each patient received individual doses of gonadotropins, FSH, and/or human menopausal gonadotropin, starting on day 2 or 3 of the menstrual cycle. Recombinant human chorionic gonadotropin (hCG) was administered to the patient to induce final follicular maturation when the dominant follicles reached a diameter of ≥ 18 mm ( 26 , 27 ). With respect to the standard clinical practice of oocyte retrieval at the Center for Reproductive Medicine, Renji Hospital, all accessible follicles were punctured and aspirated using a 16-gauge needle under ultrasound guidance 35–37 h after the administration of recombinant hCG.…”

Optimization of assisted reproductive technology outcomes in patients with polycystic ovarian syndrome: updates and unanswered questions

“…Among 115 patients in a prospective study, Garcia-Velasco et al [18] demonstrated that a shorter period of COCs 12-16 days had no effect on pregnancy outcomes in regularly cycling patients who underwent IVF. Most of the studies examining the impact of precycle COC use have been performed in normal responders and excluded individuals with PCOS [19].…”

GnRH antagonist weakens endometrial stromal cells growth ability by decreasing c-kit receptor expression

“…Patients with endometrial thickness less than 8 mm experienced lower implantation and pregnancy rate [ 12 ]. Significantly, recent studies have proved that patients treated with GnRH-ant protocol developed a remarkably thinner endometrial thickness than patients treated with GnRH-a protocol [ 13 , 14 ]. These results implied that one of the adverse effects of GnRH-ant on endometrium was to weaken endometrial thickness.…”