A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients.
BACKGROUND
This randomized controlled trial was designed to assess the impact of oral contraceptive (OC) scheduling with a GnRH antagonist (ganirelix) regimen on the ovarian response of women undergoing recombinant FSH (rFSH) stimulation for IVF, compared with a non-scheduled ganirelix regimen and a long GnRH agonist (nafarelin) protocol.


METHODS
A total of 110 women was treated with an OC and ganirelix, 111 with ganirelix alone and 111 with nafarelin. The OC (containing 30 microg ethinylestradiol/150 microg desogestrel) was taken for 14-28 days and stopped 2 days prior to the start of rFSH treatment. Primary efficiency parameters were the number of cumulus-oocyte complexes (per attempt) and the number of grade 1 or 2 embryos (per attempt).


RESULTS
In terms of follicular growth and hormone profiles, the OC-scheduled antagonist regimen mimicked the agonist regimen rather than the (non-scheduled) GnRH antagonist regimen. In the OC-scheduled GnRH antagonist group and the nafarelin group (versus the non-scheduled antagonist group), pituitary suppression was more profound at the start of stimulation (P < or = 0.001), there was a slower start of follicular growth (P < or = 0.001), longer stimulation was required (11.7 and 10.3 days respectively versus 9.4; P < or = 0.001), and more rFSH was used (2667 and 2222 IU versus 1966 IU; P < or = 0.001). In the three groups, the number of oocytes was similar (13.1, 12.9 and 11.5 respectively; not significant) as well as the number of good quality embryos (5.1, 5.7 and 5.0 respectively; not significant).


CONCLUSIONS
OC treatment prior to the rFSH/ganirelix regimen can be successfully applied to schedule patients, although more days of stimulation and more rFSH are required than with a non-scheduled GnRH antagonist regimen.
Rombauts
Luk
L
Monash IVF and Department of Obstetrics and Gynecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia. lukrombauts@hotmail.com
Healy
David
D
Norman
Rob J
RJ
D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D017135:Desogestrel / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004622:Embryo, Mammalian / Q000166:cytology; D004958:Estradiol / Q000097:blood; D004997:Ethinyl Estradiol / Q000008:administration & dosage*; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors; D006728:Hormones / Q000097:blood*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D017274:Nafarelin / Q000008:administration & dosage; D009865:Oocytes / Q000166:cytology; D006080:Ovarian Follicle / Q000187:drug effects* / Q000254:growth & development; D010062:Ovulation Induction
D003276:Contraceptives, Oral; D005300:Fertility Agents, Female; D006728:Hormones; D017274:Nafarelin; D007987:Gonadotropin-Releasing Hormone; D004997:Ethinyl Estradiol; D004958:Estradiol; D017135:Desogestrel; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; C061018:ganirelix