title: Effectiveness of indometacin to prevent ovulation in modified natural-cycle IVF: a randomized controlled trial.
abstract: Modified natural-cycle IVF has a lower pregnancy rate per started cycle as compared with IVF with ovarian stimulation due to, for example, premature ovulation. Indometacin administered before ovulation prevents follicle rupture. Therefore, addition of indometacin may improve the effectiveness of modified natural-cycle IVF. This double-blind, randomized, placebo-controlled trial with indometacin or placebo in 120 women aged 27-36 years compared the number of patients without premature ovulation as compared with the number of patients with one or more ovulations in a maximum of six cycles. Indometacin had no significant influence on the probability of a premature ovulation in patients during the six cycles (OR 2.38, 95% CI 0.94-6.04). A subgroup analysis showed a significant influence of indometacin in decreasing the probability of a premature ovulation in cycles without LH surge at the day of human chorionic gonadotrophin administration (OR 8.29, 95% CI 1.63-42.3, P=0.009). Although this study could not detect a significantly lower ovulation rate in the indometacin group versus the placebo group, the data suggest that a subgroup of patients without LH surge prior to oocyte retrieval might benefit from indometacin in modified natural-cycle IVF.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Groningen, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands. t.m.rijken@umcg.nl
authors.forename: T M
authors.initials: TM
authors.lastname: Rijken-Zijlstra
authors.forename: M L
authors.initials: ML
authors.lastname: Haadsma
authors.forename: C
authors.initials: C
authors.lastname: Hammer
authors.forename: J G M
authors.initials: JG
authors.lastname: Burgerhof
authors.forename: M J
authors.initials: MJ
authors.lastname: Pelinck
authors.forename: A H M
authors.initials: AH
authors.lastname: Simons
authors.forename: J
authors.initials: J
authors.lastname: van Echten-Arends
authors.forename: J G E M
authors.initials: JG
authors.lastname: Arts
authors.forename: J A
authors.initials: JA
authors.lastname: Land
authors.forename: H
authors.initials: H
authors.lastname: Groen
authors.forename: A
authors.initials: A
authors.lastname: Hoek
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D054315:Oocyte Retrieval; D006080:Ovarian Follicle / Q000187:drug effects; D010060:Ovulation / Q000187:drug effects*; D034445:Ovulation Inhibition / Q000187:drug effects*; D011247:Pregnancy; D018873:Pregnancy Rate
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin
keywords: IVF; indometacin; minimal stimulation; modified natural-cycle; nonsteroidal anti-inflammatory drug (NSAID); ovulation