Gonadotropin stimulation of the patient with polycystic ovarian syndrome: a comparison of oral contraceptive pill/dual suppression lupron protocol versus oral contraceptive/antagonist protocol

Abstract

To evaluate in vitro fertilization (IVF) cycle outcomes in polycystic ovarian syndrome (PCOS) patients with an oral contraceptive pill (OCP)/Lupron protocol versus an OCP/Antagonist protocol. Retrospective cohort study. The study included 309 patients who underwent 395 cycles of controlled ovarian hyperstimulation and IVF from January of 2004 to December of 2010. All patients met Rotterdam criteria for diagnosis of PCOS. Primary outcome measures include clinical pregnancy rate, percent cycles coasted, cancelled, and resulting in cryopreservation secondary to risk of ovarian hyperstimulation syndrome (OHSS), as well as occurrence of moderate or severe OHSS. Secondary outcome measures include length of stimulation, number of oocytes retrieved, number of mature oocytes, and implantation rate. Paired t tests and chi square test were used in analysis. P<0.05 was considered statistically significant. Results are shown in Table 1.Tabled 1OCP/AntagonistOCP/LupronP valueNumber of cycles81314Age31.9 ± 4.731.5 ± 4.1NSBMI23.7 ± 7.624.7 ± 6.8NSDays of stimulation10.2 ± 2.212.7 ± 2.60.02Coasts (%/cycle)1(1.2)31(9.8)0.02Cancelled due to risk of hyper response (%/cycle)2(2.5)17(5.4)NSEggs/retrieval16.8 ± 9.914.4 ± 7.10.02Mature eggs/retrieval13.8 ± 8.611.8 ± 6.10.02Frozen upfront for risk of OHSS(% per cycle)1(1.3)10(3.4)NSImplantation rate day 3 ET*43.1 ± 3639.4 ± 41.6NSImplantation rate day 5 ET*56.8 ± 49.552.1 ± 44.0NSTotal pregnancies (%/ET, %/cycle)195(69.7,62.1)56(75.7,69.1)NSClinical pregnancies (%/ET, %/cycle)168(60.2,53.5)49(66.2,60.0)NSLive birth/Ongoing pregnancies (%/ET, %/cycle)143(51.2,45.5)41(55.4,50.6)NSModerate OHSS(%)05(1.9)NSTable 1. * Embryo transfer (ET). Open table in a new tab Table 1. * Embryo transfer (ET). When compared to a dual suppression OCP/Lupron protocol, use of an OCP/Antagonist protocol in patients with PCOS results in more eggs retrieved, fewer days of stimulation, a lower rate of coasting, and less risk of OHSS. No cases of severe OHSS were identified in either group.