Abstract
ObjectiveConcern regarding the adverse impact of pretreatment of oral contraceptives (OC) prior to ovarian stimulation for in vitro fertilization (IVF) on pregnancy outcome has been debated. We investigated factors that may be associated with live birth rate (LBR) in fresh embryo transfer cycles after OC pretreatment.MethodsA retrospective study was conducted at the Reproductive Center of Ren Ji Hospital, Shanghai, China. 814 women aged 20–35 years undergoing their first autologous IVF cycle and fresh embryo transfer after OC pretreatment were included. Long gonadotropin releasing hormone (GnRH) agonist (a) or GnRH antagonist (ant) protocol was used for ovarian stimulation. Predictive factors for LBR were identified using multivariate logistic regression analysis.ResultsMultivariate logistic regression analysis demonstrated that using GnRH-ant protocol for ovarian stimulation was associated with significantly lower LBR (OR 0.70, 95% CI 0.52–0.93), while endometrial thickness on day of hCG trigger was associated with increased LBR (OR 1.16, 95% CI 1.06–1.27). Despite comparable patients’ age, duration of infertility, BMI and basal FSH between GnRH-a and GnRH-ant groups, those using GnRH-ant resulted in significantly lower LBR compared to the GnRH-a group (37.4 vs. 48.5%, p = 0.002). Using ROC analysis and a cut-off endometrial thickness of < and ≥ 9.5 mm, those < 9.5 mm using GnRH-ant resulted in significantly lower LBR (28.5 vs. 43.4%, p = 0.004), while no differences were noted with an endometrial thickness ≥9.5 mm (49.6 vs. 51.1%, p = 0.78).ConclusionsLive birth was significantly impacted in OC pre-treated GnRH-ant cycles with an endometrial thickness of <9.5 mm on day of hCG trigger. Cryopreservation of all embryos in these cycles should be considered.
Highlights
Oral contraceptives (OC) have been widely used to prevent pregnancy, and for the treatment of dysmenorrhea or menstrual disorders since being first approved in 1960 (Golobof and Kiley, 2016)
Results of multivariate logistic regression analysis demonstrated that using a gonadotropin releasing hormone (GnRH)-ant protocol was significantly associated with lowered live birth rate (LBR), while endometrial thickness on day of hCG trigger was associated with increased LBR (Table 2)
Our results suggest that in fresh embryo transfer cycles after OC pretreatment, using GnRH-ant protocol for ovarian stimulation was associated with significantly lower LBR, while endometrial thickness on day of hCG trigger was associated with a greater LBR
Summary
Oral contraceptives (OC) have been widely used to prevent pregnancy, and for the treatment of dysmenorrhea or menstrual disorders since being first approved in 1960 (Golobof and Kiley, 2016). With the increasing utilization of in vitro fertilizationembryo transfer (IVF-ET) world-wide, OC have extensively been employed as a pretreatment before controlled ovarian stimulation in IVF cycles (Farquhar et al, 2017). Recently there have been an increasing number of studies reporting the use of OC pretreatment may be potentially related to impaired pregnancy outcomes after fresh embryo transfers (Garcia-Velasco and Fatemi, 2015; Farquhar et al, 2017; Wei et al, 2017; Xu et al, 2019b; Lu et al, 2020). A recent Cochrane meta-analysis by Farquhar et al which included six randomized controlled trials (RCTs) showed that OC pretreatment was associated with a lower ongoing pregnancy rate or live birth rate (LBR) after fresh embryo transfer than no pretreatment in gonadotropin releasing hormone (GnRH) antagonist (ant) cycles. Other retrospective studies reported that patients using OC pretreatment had similar probabilities of achieving a live birth compared to patients notusing OC following fresh embryo transfer in both GnRH-ant and GnRH agonist (a) protocols (Xu et al, 2019a; Montoya-Botero et al, 2020)
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