title: Steroids pretreatment in assisted reproduction cycles.
abstract: The objective is to present an overview of trials and appreciate the relevant data on the effect of steroids pretreatment (oral contraceptives, 17β-estradiol and estradiol valerate) in assisted reproduction cycles. The subject of the study is to evaluate the clinical characteristics during steroids pretreatment cycles focused on the prevention of ovarian cysts, the positive contraceptive effect on the onset of regular period during long gonadotropin releasing hormone agonist protocol. In gonadotropin releasing hormone antagonist protocol the review is interested in supporting ovarian stimulation in low responders, the idea of cycle scheduling and improving treatment outcomes. The method is a review from MEDLINE/Pubmed database between 1994 and July 2012. We identified 15 randomised controlled trials (n=3069 patients). One trail (n=83 patients) assessed GnRH agonist protocol with or without steroids pretreatment, 8 trials (n=1884 patients) assessed GnRH antagonist protocols with or without steroids pretreatment and 6 trials (n=1102 patients) assessed GnRH antagonist protocols versus agonist ones with steroid pretreatment. Data demonstrates that oral contraceptives offer the effective prevention of functional ovarian cysts, the predictable onset of period during desensitisation. Existing data suggest that pretreatment with oral contraceptive pills or estradiol valerate give no advantage concerning number of oocytes or pregnancy rate. Pretreatment with oral contraceptive pills aiming to avoid weekend oocytes retrievals has to be more elucidated. In low responders oral contraceptive pill pretreatment may be beneficial in improving ovarian responses by reducing the amount of gonadotropins and the number of days required for ovarian stimulation. Current research indicates that also 17β-estradiol may be encouraging pretreatment in low responders and in cycle scheduling. This article is part of a Special Issue entitled 'Pregnancy and Steroids'.
authors.affiliation: Department of Urology, Third Faculty of Medicine, Charles University Prague, Czech Republic.
authors.forename: V
authors.initials: V
authors.lastname: Sobotka
authors.forename: R
authors.initials: R
authors.lastname: Streda
authors.forename: T
authors.initials: T
authors.lastname: Mardesic
authors.forename: J
authors.initials: J
authors.lastname: Tosner
authors.forename: J
authors.initials: J
authors.lastname: Heracek
mesh_terms: D003276:Contraceptives, Oral / Q000008:administration & dosage*; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors / Q000502:physiology; D006801:Humans; D010048:Ovarian Cysts / Q000517:prevention & control; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted; D016896:Treatment Outcome
chemical_list: D003276:Contraceptives, Oral; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol
keywords: 17β-Estradiol; 2PN; AMH; Assisted reproduction; Estradiol valerate; FSH; GnRH; ICSI; IVF; LH; MII; OHSS; Oral contraceptives; PCOS; RCT; Steroids pretreatment; anti Mullerian hormone; follicle stimulating hormone; gonadotropin releasing hormone; hCG; human chorionic gonadotropin; in vitro fertilisation; intracytoplasmic sperm injection; luteinising hormone; metaphase of the second meiotic division; ovarian hyperstimulation syndrome; polycystic ovary syndrome; randomised controlled trial; two pronucleate stage