Use of oral contraceptives in assisted reproductive cycles

Abstract

Oral contraceptive (OC) pills are commonly used in patients undergoing in vitro fertilization to schedule cycle starts. This often helps with staff scheduling and efficiency. In this paper, the use of OC pre-treatment in assisted reproductive cycles will be discussed. The focus will be on the use of OC in gonadotropin releasing hormone (GnRH) antagonist cycles, GnRH agonist cycles, poor responders and finally in high responders. A recent meta-analysis of six randomized control trials concluded that in cycles with GnRH-antagonist protocols, OC pre-treatment: (1) Increases the duration of stimulation, (2) increases the total dose of gonadotropins and (3) resulted in a small but significant reduction in pregnancy rates. All these studies used pure follicle stimulating hormone for controlled ovarian hyperstimulation. These conclusions, however, may not be valid in cycles where the birth control pill free interval is 5 days, and there is use of combination protocols (luteinizing hormone or human menopausal gonadotropin add back). 17β-estradiol (E2, 4 mg/d) pre-treatment is a viable alternative to using OC. However, in these patients, gonadotropin stimulation should be started on the first day of estrogen discontinuation. In GnRH agonist cycles, pre-treatment with OC reduces the formation of functional ovarian cysts and may reduce the incidence of ovarian hyperstimulation syndrome.