Effect of an oral contraceptive pill on follicular development in IVF/ICSI patients receiving a GnRH antagonist: a randomized study.
This randomized controlled study compared the effectiveness of a gonadotrophin releasing hormone (GnRH) antagonist protocol with or without oral contraceptive (OC) pretreatment on the number of oocytes retrieved in IVF or intracytoplasmic sperm injection (ICSI) patients. Sixty-four patients were randomized to start recombinant human FSH (r-hFSH) on day 2 or 3 after OC withdrawal (OC group) or on day 2 of a natural cycle (control group). From stimulation day 6 onwards, all patients were treated with daily (0.5 mg/ml) GnRH antagonist (Antide). OC pretreatment resulted in significantly lower starting concentrations of FSH, LH and oestradiol (P < 0.001) and a thinner endometrium (P < 0.0001). In the early stimulation period, fewer large follicles were found after OC pretreatment, leading to a significantly extended stimulation period (11.6 versus 8.7 days, P < 0.0001) with more follicles on the day of recombinant human chorionic gonadotrophin administration (15.4 versus 12.5, P = 0.02) and more oocytes retrieved (13.5 versus 10.2, P < 0.001) as compared with the control group. GnRH antagonist regimen, pretreated with OC, prevented the early endogenous FSH rise and improved follicular homogeneity, resulting in more oocytes. As a consequence of the extended treatment period, more rhFSH was required.
Huirne
Judith A F
JA
Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Centre (VUmc), Amsterdam, the Netherlands.
van Loenen
Andre C D
AC
Donnez
Jacques
J
Pirard
Céline
C
Homburg
Roy
R
Schats
Roel
R
McDonnell
Joseph
J
Lambalk
Cornelis B
CB
D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects / Q000494:pharmacology*; D004717:Endometrium / Q000187:drug effects; D004958:Estradiol / Q000097:blood; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000494:pharmacology*; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000009:adverse effects / Q000097:blood / Q000494:pharmacology; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007986:Luteinizing Hormone / Q000097:blood; D009842:Oligopeptides / Q000009:adverse effects / Q000494:pharmacology; D009865:Oocytes / Q000187:drug effects; D006080:Ovarian Follicle / Q000187:drug effects* / Q000254:growth & development; D016471:Ovarian Hyperstimulation Syndrome / Q000139:chemically induced; D011994:Recombinant Proteins / Q000494:pharmacology; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects
D003278:Contraceptives, Oral, Hormonal; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D009842:Oligopeptides; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; C057022:iturelix