Does the pretreatment with oral contraceptive pill during long luteal protocol of leuprolide acetate effect the cycle outcome in ICSI patients

Abstract

OBJECTIVE: The aim of this study was to compare oral contraceptive (OC) pretreatment in addition to GnRH-analog (GnRHa) long luteal protocol with standard long luteal protocol among normoresponder ICSI patients.DESIGN: Retrospective analysis.MATERIALS AND METHODS: All of the patients used GnRHa long protocol for ICSI and were divided into two groups according to OC administration. Patients in the Group A (n=50) were treated with a standard long protocol of leuprolide acetate initiated on the 21st day of the menstrual cycle, patients in the Group B (n=110) were pretreated with an OC for 21 days starting on the first day of menstruation. The administration of leuprolide acetate was initiated on the 15th day of OC administration until the hCG day. When pituitary suppression was achieved, ovarian hyperstimulation was commenced depending on the patients' individual characteristics.RESULTS: There were no statistically significant differences recorded in the demographic characteristics of patients including age, BMI, day 3 FSH level between groups. However, day 3 E2 level is statistically higher in Group A than Group B (48.54±46.18, 31.7±27.41, p=0.001). No differences were found between the groups in terms of developed ovarian cysts, the mean number of stimulation days, total dose of gonadotropins used, estradiol level and endometrial thickness on the day of hCG administration. Coasting cycles were significantly higher in Group B than Group A (22.5% vs 6.5%, P=0.02, respectively). Despite, in Group A number of mature (M2) oocytes (10.44±4.73 vs 8.84±3.56, P=0.02) were significantly higher than OC pretreated group, number of 2 PN embryos (8.45±9.5 vs 6.75±3.05, P=0.63) were similar between groups. Fertilization rates (76.7%, 67.8%, respectively) and top quality (grade A) embryos (82.1%, 72.1%, respectively) were significantly higher in Group B than Group A (P=0.009, P=0.018). There were no significant differences between groups in regards of implantation (16% vs 21.8%, P=0.497, respectively) and clinical pregnancy rates (32% vs 35.5%, P=0.67, respectively) between groups. Number of the cycles cancelled as a result of poor ovarian response or ovarian hyperstimulation syndrome (OHSS) were similar in both groups.CONCLUSIONS: Pretreatment with OC during long luteal protocol does not improve cycle outcome among normoresponder ICSI patients. OBJECTIVE: The aim of this study was to compare oral contraceptive (OC) pretreatment in addition to GnRH-analog (GnRHa) long luteal protocol with standard long luteal protocol among normoresponder ICSI patients. DESIGN: Retrospective analysis. MATERIALS AND METHODS: All of the patients used GnRHa long protocol for ICSI and were divided into two groups according to OC administration. Patients in the Group A (n=50) were treated with a standard long protocol of leuprolide acetate initiated on the 21st day of the menstrual cycle, patients in the Group B (n=110) were pretreated with an OC for 21 days starting on the first day of menstruation. The administration of leuprolide acetate was initiated on the 15th day of OC administration until the hCG day. When pituitary suppression was achieved, ovarian hyperstimulation was commenced depending on the patients' individual characteristics. RESULTS: There were no statistically significant differences recorded in the demographic characteristics of patients including age, BMI, day 3 FSH level between groups. However, day 3 E2 level is statistically higher in Group A than Group B (48.54±46.18, 31.7±27.41, p=0.001). No differences were found between the groups in terms of developed ovarian cysts, the mean number of stimulation days, total dose of gonadotropins used, estradiol level and endometrial thickness on the day of hCG administration. Coasting cycles were significantly higher in Group B than Group A (22.5% vs 6.5%, P=0.02, respectively). Despite, in Group A number of mature (M2) oocytes (10.44±4.73 vs 8.84±3.56, P=0.02) were significantly higher than OC pretreated group, number of 2 PN embryos (8.45±9.5 vs 6.75±3.05, P=0.63) were similar between groups. Fertilization rates (76.7%, 67.8%, respectively) and top quality (grade A) embryos (82.1%, 72.1%, respectively) were significantly higher in Group B than Group A (P=0.009, P=0.018). There were no significant differences between groups in regards of implantation (16% vs 21.8%, P=0.497, respectively) and clinical pregnancy rates (32% vs 35.5%, P=0.67, respectively) between groups. Number of the cycles cancelled as a result of poor ovarian response or ovarian hyperstimulation syndrome (OHSS) were similar in both groups. CONCLUSIONS: Pretreatment with OC during long luteal protocol does not improve cycle outcome among normoresponder ICSI patients.