Oral contraceptive pretreatment for scheduling in IVF patients treated with either rFSH/GnRH Antagonist or rFSH/GnRH agonist

Abstract

Objectives: (1) To compare the clinical effects of oral contraceptive pill (OCP) pretreatment for cycle scheduling in rFSH/GnRH antagonist (ANT) vs. rFSH/GnRH agonist (AG) stimulation in IVF patients, and (2) to evaluate optimization of retrieval day with OCP. Design: Prospective, randomized. Material and Methods: Four study centers equally recruited 80 patients with inclusion criteria: age≤ 38, d3 FSH ≤ 10, basal antral follicle > 5, 19<BMI <32, 26< cycle day (CD) <34, and ≤1 previous ART cycle. All subjects began OCP (Desogen®, Organon USA, Roseland, NJ) on CD 2–4 and discontinued on a Sunday after 14–28 d of treatment. Evening dosing of rFSH (Follistim®, Organon USA) at 300 IU/day began on the Friday (5th day post OCP) following OCP discontinuation. Dose adjustments of 75–150 IU rFSH were allowed. In AG group, GnRH agonist (Lupron®, TAP, Chicago, IL) had a 5 day overlap with OCP at 0.5 mg/d and decreased to 0.25 mg/d with rFSH start. In ANT group (Antagon(tm), Organon USA), an evening dose of 250 μg/d ANT was initiated when lead follicle had a mean diameter of 12–14 mm. HCG was administered when 2 or more follicles reach ≥16–18 mm. ET occurred on d2, 3 or 5. According to individual clinic protocols, luteal support was provided. Serum β-hCG and ultrasound confirmed clinical pregnancy. Results: Of 80 patients, 39 were randomized to ANT and 41 in AG; 36 in ANT and 40 in AG to embryo transfer. Cancellations were: ANT- 2 poor response, 1 personal reason; AG- 1 no fertilization. There were no differences in patient age, BMI, day 3 FSH and OCP duration between ANT and AG. The mean (±SE, range) number of days of rFSH in ANT (9.1 + 0.3, 6–12) and AG (9.0 + 0.2, 6–12) was not different. The dose of gonadotropin utilized was similar between ANT and AG (2706 + 146 vs 2724 + 118, respectively). Patient outcomes were similar in the number of oocytes retrieved, number of embryos, ongoing pregnancy rate and implantation rate. OCP cycle scheduling resulted in 89% and 95% of retrievals performed on five days of week for ANT and AG, respectively. Conclusions: OCP pretreatment in rFSH/ANT protocols for IVF provides a patient-friendly regimen with fewer injections and can be optimized for weekday retrievals. There was no difference in number of oocytes retrieved, 2 PN embryos, embryos transferred, implantation and pregnancy rates between the two stimulation protocols. To optimize scheduling for weekday retrievals, OCP pretreatment should be discontinued on Monday (vs. Sunday) and rFSH should be initiated on Saturday (vs. Friday). Supported by: an unrestricted educational grant from Organon Pharmaceuticals Inc.