Oral contraceptive pretreatment does not improve outcome in microdose gonadotrophin-releasing hormone agonist protocol among poor responder intracytoplasmic sperm injection patients

Abstract

Purpose To compare oral contraceptive (OC) pretreatment plus microdose GnRH-a in flare-up protocol and non-OC microdose GnRH-a in flare-up protocol among poor responder ICSI patients. Methods A retrospective analysis of poor responder ICSI patients. Patients were divided into two groups according to used microdose protocol. Precycle treatment with OC followed by follicular phase administration of 40 μg sc leuprolide acetate (LA) every 12 h beginning on after 2 day pill-free period and rFSH administration was begun on the third day of LA administration (OC-Group, n=26). Alternatively on day 2 after menses, patients were administered similar stimulation regime (non-OC Group, n=27). Results There were no significant differences between groups in the number of oocytes, peak estradiol levels, endometrial thickness, fertilization rates and embryo quality. Implantations and pregnancy rates per embryo transfer were similar. Conclusion OC pretreatment plus microdose GnRHa in flare-up protocol does not offer advantages over non-OC microdose GnRHa in flare-up protocol among poor responder ICSI patients.

Comparison of the ultrashort gonadotropin-releasing hormone agonist-antagonist protocol with microdose flare-up protocol in poor responders: a preliminary study

“…Furthermore, implantations and pregnancy rates per embryo transfer were similar. As a result of our previous study, we thought that this preference should not affect the outcomes of the microdose protocol negatively (34). The major weakness of our study is the limited number of couples undergoing the ICSI procedures investigated.…”

Pretreatment with Oral Contraceptive Pills Does Not Influence the Pregnancy Rate in the Long Leuprolide Acetate Protocol

“…Apart from the above-mentioned studies, available experience with leuprolide acetate and OCP is limited to studies evaluating hyperresponder [12] or poor responder [13,14] cohorts of women. Among high responder patients, premedication with an OCP might decrease the cancellation rate and increase both the clinical and ongoing pregnancy rates when compared with their previous IVF cycle without OCP pretreatment [12].…”

“…leuprolide acetate may enhance the follicular response to exogenous gonadotropin in patients who presented a poor response in the long leuprolide acetate protocol in their initial attempt [14]. However, according to a recent trial [13], this positive effect seems to be related with low-dose leuprolide acetate usage rather than OCP itself. The pregnancy rate among OCP pretreated (n = 26) and untreated (n = 27) groups is not statistically significant (15 vs. 14%, respectively) when all patients underwent a microdose flare-up protocol [13].…”

“…However, according to a recent trial [13], this positive effect seems to be related with low-dose leuprolide acetate usage rather than OCP itself. The pregnancy rate among OCP pretreated (n = 26) and untreated (n = 27) groups is not statistically significant (15 vs. 14%, respectively) when all patients underwent a microdose flare-up protocol [13]. …”

Annulations en fécondation in vitro : mauvais pronostic, mauvaises répondeuses, ou variabilité de la réponse à la stimulation ? Analyse de 142 annulations

“…Cette situation concernant neuf à 24 % des cycles selon les études [1,2]. Différentes prises en charge ont été proposées dans la littérature pour optimiser les réponses à la stimulation ovarienne chez les patientes ayant eu une annulation pour mauvaise réponse : la fécondation in vitro en cycle naturel modifié (FIVnm) [3], l'utilisation des antagonistes [4][5][6][7], des supplémentassions de la phase lutéale par de la LH [8], le prétraitement par pilule oestroprogestative [9], l'utilisation de l'aspirine à faibles doses (81 mg/j) [10], ou l'augmentation des doses de gonadotrophines [11,12], la prolongation de la stimulation ovarienne [13], ou l'utilisation de facteurs de croissance [14,15]. Mais, aucune de ces propositions n'a démontré sa supé-riorité dans le cas des mauvaises répondeuses [16].…”