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

Smulders, Brechtje; Oirschot, Sanne M van; Farquhar, Cindy; Rombauts, Luk; Kremer, J.A.M.

doi:10.1002/14651858.cd006109.pub2

Cited by 41 publications

(24 citation statements)

References 90 publications

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“…Conversely, in a RCT including 425 patients, Kolibianakis et al [21] observed a significantly higher early pregnancy loss in the OCP pretreatment arm, whereas ongoing pregnancy rates were similar between the 2 groups. Recently, a review from the Cochrane database suggested that combined OCP in GnRH antagonist cycles, compared to no pre-treatment, is associated with fewer clinical pregnancies and poorer pregnancy outcome [22]. …”

Section: Discussionmentioning

confidence: 99%

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

Decanter

Robin

Thomas

et al. 2013

Reprod Biol Endocrinol

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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.

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Section: Discussionmentioning

confidence: 99%

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

Decanter

Robin

Thomas

et al. 2013

Reprod Biol Endocrinol

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“…Over the years multiple protocols for ovarian stimulation have been developed containing different combinations of gonadotropins, GnRH analogues and other adjuvants [1-3]. Despite the differences between protocols it is clear that the major component responsible for follicular maturation is follicle stimulating hormone (FSH) [4].…”

Section: Introductionmentioning

confidence: 99%

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

Bentov

Burstein

Firestone

et al. 2013

Reprod Biol Endocrinol

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BackgroundWhen stimulating a patient with poor ovarian response for IVF, the maximal dose of gonadotropins injected is often determined by arbitrary standards rather than a measured response. The purpose of this study was to determine if serum FSH concentration during an IVF stimulation cycle reflects follicular utilization of FSH and whether serum FSH values may inform dose adjustments of exogenous FSH.MethodsIn this retrospective cross sectional study we studied 155 consecutive IVF cycles stimulated only with recombinant human FSH. We only included long GnRH agonist protocols in which endogenous FSH levels were suppressed. We correlated the serum concentration of cycle day (CD) 7 FSH with the number of oocytes retrieved, cleaving embryos and pregnancy rate.ResultsWe found that a CD7 FSH concentration above 22 IU/L was associated with poor response regardless of the daily dose of FSH injected and a lower pregnancy rate.ConclusionsWe concluded that CD7 FSH concentration during stimulation could be used to guide FSH dosing in poor responders. If the CD7 FSH concentration is above 22 IU/L increasing the dose of FSH in an attempt to recruit more growing follicles is unlikely to be successful.

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“…COS with GnRH-ant based protocols can be preceded by pretreatment with oral contraceptive pills (OCPs) or estrogen, with the goal of synchronizing follicular growth [56]. Most of these findings have been reported in studies comparing OCPs [789101112] or estrogen [513141516] to no pretreatment. However, scarce data are available comparing transdermal pretreatment modalities to standard pretreatment modalities in terms of COS, embryological, or pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 99%

Pretreatment of normal responders in freshin vitrofertilization cycles: A comparison of transdermal estradiol and oral contraceptive pills

Pereira

Petrini

Zhou

et al. 2016

Clin Exp Reprod Med

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ObjectiveThe aim of this study was to investigate the impact of pretreatment with transdermal estradiol (E2) compared to oral contraceptive pills (OCPs) on controlled ovarian stimulation (COS) response in normal responders undergoing fresh in vitro fertilization (IVF)-embryo transfer (ET) cycles.MethodsA retrospective cohort study was performed of normal responders undergoing fresh IVF-ET cycles who received pretreatment with transdermal E2 versus OCPs prior to fresh IVF-ET. The total days of ovarian stimulation, total dosage of gonadotropins, total number of oocytes, and mature oocytes retrieved were noted. Pregnancy outcomes after ET were also recorded.ResultsA total of 2,092 patients met the inclusion criteria: 1,057 and 1,035 patients in the transdermal E2 and OCP groups, respectively. Patients in the OCP group had a longer duration of COS (10.7±1.63 days, p<0.01) than the E2 group (9.92±1.94 days). Patients in the OCP group also required higher cumulative doses of gonadotropins (2,657.3±1,187.9 IU) than those in the E2 group (2,550.1±1,270.2 IU, p=0.002). No statistically significant differences were found in the total and mature oocytes retrieved or in the rates of biochemical pregnancy, clinical pregnancy, spontaneous miscarriage, and live birth between the groups.ConclusionOur findings suggest that compared to OCPs, pretreatment with transdermal E2 is associated with a shorter duration of ovarian stimulation and lower gonadotropin utilization, without compromising the oocyte yield or pregnancy outcomes in normal-responder patients undergoing fresh IVF.

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

Cited by 41 publications

References 90 publications

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

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

Can cycle day 7 FSH concentration during controlled ovarian stimulation be used to guide FSH dosing for in vitro fertilization?

Pretreatment of normal responders in freshin vitrofertilization cycles: A comparison of transdermal estradiol and oral contraceptive pills

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