Formation of functional ovarian cysts in IVF cycles does not decrease with prior oral contraceptive use and does not effect ovarian stimulation outcomes

Abstract

OBJECTIVE: To determine if functional ovarian cysts are decreased by oral contraceptive use prior to GnRH agonist long luteal protocol. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All patients undergoing ART in 2004 and 2006 who gave IRB consent were considered for analysis. Patients who took oral contraceptive pills (OCP) for at least 30 days prior to their IVF cycle were compared to those who did not take any OCP's. The incidence of functional cyst formation after GnRH agonist long luteal protocol was calculated for both groups. Cysts were defined as functional if the baseline estradiol level was >35 pg/mL. In each case of a functional cyst, one of the following decisions was made (a) continuing GnRH agonist therapy for 7-14 days prior to stimulation, (b) aspirating the cyst, (c) continuing with the stimulation or (d) cancelling the cycle. After ovarian stimulation the peak E2 level and the number of total and mature oocytes retrieved were recorded. Data were analyzed using chi square, ANOVA and student t-test. RESULTS: Of 192 IVF cycles, 32 patients were found to have ovarian cysts prior to starting GnRH agonist and were excluded. The incidence of functional ovarian cyst formation was 7.5% (12/160). Prior OCP use did not decrease the incidence of functional cyst formation (Table 1). In 12 IVF cycles a functional cyst was noted. GnRH agonist was continued for 7-14 days in 8/12 cycles. The cycle was continued with stimulation in two cases, cyst aspiration was performed in one case and one cycle was cancelled. No difference was seen in peak E2 levels and number of total and mautre oocytes retrieved in patients with functional cysts vs. those without cysts (Table 2).Table 1Development Of Functional CystsPatients Without CystsPatients With CystsNo prior OCP use917Prior OCP use575p value=0.83. Open table in a new tab Table 2Ovarian Stimulation OutcomesPatients Without CystsPatients With Cystsp-valuePeak E2 level210124870.28Total Oocytes14.914.00.82Mature Oocytes10.749.730.58 Open table in a new tab p value=0.83. CONCLUSIONS: The incidence of functional cyst formation in our study was consistent with numbers reported in the literature. In our patient population, functional cysts developed even with prior OCP use which has not been previously reported. Functional cysts can lead to impaired ovarian stimulation and contribute to poor IVF outcomes. In our study, ovarian stimulation was not affected if a clinical intervention was performed.