Comparison of GnRH antagonist cycles with and without oral contraceptive pill pretreatment in poor responders

Abstract

Objective: One of the most difficult challenges in the practice of assisted reproductive technologies is the management of poor responders. Previous studies examining the use of oral contraceptive pills (OCPs) with in vitro fertilization (IVF) cycles have reported positive benefits: a decrease in time needed for suppression, decrease in the amount of gonadotropins needed for stimulation, elimination of premature LH surges, and possible improvement in pregnancy rates. However, these studies examining the effects of OCPs have all been performed with GnRH agonists using either a long or flare protocol. In the present study, we seek to compare IVF outcomes in poor responders undergoing GnRH antagonist cycles with and without the use of oral contraceptive pills before ovarian stimulation. Design: Retrospective study of patients undergoing IVF August 2001–August 2002. Materials and Methods: We evaluated records from 194 cycles in which GnRH antagonists were used in patients identified as poor responders. Medical charts were evaluated for patient characteristics, cycle types, as well as pregnancy outcomes. Use of OCP pretreatment was based on scheduling availability or patient preference. Results: During the study period, 138 patients underwent 194 antagonist cycles, both with oral contraceptive pills (n=146) and without oral contraceptive pills (n=48). The two groups did not differ in age, gravity, parity, day 3 FSH, number of previous cycles or cause of infertility. Patients that used oral contraceptive pills required more total ampules of gonadotropins (5888 v. 4410 IU, p=0.009). The two groups of patients did not differ in number of follicles produced, oocytes retrieved or number of embryos. The pregnancy rate did not differ between the two groups. Tabled 1 Conclusion: In this patient population of poor responders, pregnancy outcomes were the same whether or not OCP pretreatment was used. Since there is no difference in pregnancy outcome, the use of OCP pretreatment may be determined by the need for scheduling flexibility. However, patients that use OCPs may require a significantly higher dose of gonadotropins for ovarian stimulation.