title: Estradiol and Antagonist Pretreatment Prior to Microdose Leuprolide in in Vitro Fertilization. Does It Improve IVF Outcomes in Poor Responders as Compared to Oral Contraceptive Pill?
abstract: OBJECTIVE
  To compare in vitro fertilization (IVF) outcomes in low responders stimulated with microdose leuprolide protocol (ML) following pretreatment with either oral contraceptive pill (OCP) or luteal estradiol (E2) + GnRH antagonist (E2 + antag) for follicular synchronization prior to controlled ovarian hyperstimulation (COH).
  
  
  METHODS
  This was a retrospective study of 130 women, who were poor responders, undergoing IVF with either OCP/ML or E2+ antag/ML protocols. The main outcome measures were ongoing pregnancy rates, number of oocytes retrieved, and cancellation rate.
  
  
  RESULTS
  Both groups were similar in baseline characteristics. There were no significant differences in gonadotropin requirement, cancellation rate, and number of embryos transferred. Ongoing pregnancy rates (40% vs. 15%) were significantly higher in the OCP/ML group. Trends toward greater number of oocytes retrieved (7.7 ± 3.4 vs. 5.9 ± 4.2) and improved implantation rates (20% vs. 12%) were also noted, but these did not reach statistical significance.
  
  
  CONCLUSIONS
  E2+antag pretreatment does not appear to improve IVF outcomes in ML protocol when compared to the standard OCP in poor responders. Randomized trials with adequate power to study the optimal method of steroid pretreatments appear justified.
authors.forename: Alyaa
authors.initials: A
authors.lastname: Elassar
authors.forename: John
authors.initials: J
authors.lastname: Nulsen
authors.forename: Lawrence
authors.initials: L
authors.lastname: Engmann
authors.forename: Claudio
authors.initials: C
authors.lastname: Benadiva
mesh_terms: D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D004958:Estradiol / Q000627:therapeutic use*; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D016729:Leuprolide / Q000627:therapeutic use; D054315:Oocyte Retrieval; D011247:Pregnancy; D018873:Pregnancy Rate; D011292:Premedication; D012189:Retrospective Studies
chemical_list: D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D005300:Fertility Agents, Female; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D016729:Leuprolide; C061018:ganirelix