Profound pituitary suppression following oral contraceptive pretreatment in GnRH antagonist cycles does not impact outcome

Abstract

To evaluate the effect of profound pituitary suppression after OCP pretreatment in women undergoing IVF using gonadotropin releasing hormone (GnRH) antagonists. Retrospective cohort study in an academic IVF center. 318 women underwent an IVF cycle utilizing OCP pretreatment with GnRH antagonist protocol from 1/2008 to 1/2010. Patients were assigned to groups based on endogenous LH level on day 1 of stimulation (4 days after OCP discontinuation). Chi-square, Students t-tests, and Pearson's correlation test were used for statistical analysis, p<0.05 considered significant. 75 women had LH levels < 1.5 mIU/mL and 243 women had LH levels > 1.5 mIU/mL. Fertilization, implantation, pregnancy, and spontaneous loss rate were similar in both groups. Significantly greater numbers of oocytes were retrieved in the LH <1.5 mIU/mL group. Longer OCP treatment was correlated with lower LH levels on first day of gonadotropin stimulation (r = −0.175, P=0.002). Greater LH suppression was correlated with increased total gonadotropin dose (r = −0.227, P<0.0001) and days of stimulation (r = −0.445, P<0.0001).Tabled 1LH < 1.5mIU/mLLH > 1.5mIU/mLP valueAge35.9 ± 4.236.5 ± 4.50.31No. days on OCPs22.4 ± 4.521.3 ± 4.20.05Cancellation rate (%)16 (12/75)12.4 (31/243)0.37Total gonadotropin use (IU)4328 ± 12663543 ± 1283<0.0001No. days of stimulation10.9 ± 0.89.5 ± 1.1<0.0001Peak E2 day of hCG (pg/mL)2091 ± 8272049 ± 9900.75Oocytes retrieved (n)17.7 ± 9.414.9 ± 7.80.02Fertilization rate/oocyte(%)56.554.90.38Implantation rate/embryo (%)26.825.60.33Clinical PR/ET(%)49.246.20.79SAB rate (%)19.312.20.48 Open table in a new tab Women with profound LH suppression following OCP pretreatment demonstrate a comparable prognosis to women who did not, despite requiring longer stimulations and a higher total gonadotropin dose. Longer OCP pretreatment results in greater LH suppression. It is possible that OCP pretreatment contributed to synchronization of the early follicular cohort leading to a greater number of oocytes retrieved.