Objective: To evaluate the effect of oral contraceptive pill (OCP) pretreatment in gonadotropin-releasing hormone (GnRH) antagonist ovarian stimulation protocol on the outcome of IVF/ICSI regarding number of retrieved oocyte, oocyte maturation rate, fertilization rate, good quality embryo rate, cycle cancellation rate, pregnancy rate and clinical
abortion rate.
Subjects & Methods:
A total of 84 patients, in a prospective controlled clinical trial, had ICSI using GnRH
antagonist protocol during the period from February 1st, 2009 to September 30th, 2011
were included in this prospective randomized trial. We compared the IVF outcomes between OCP pretreated (n=43) and no pretreatment group (n=41) in gonadotropin-releasing hormone (GnRH) antagonist ovarian stimulation protocol.
Results: The mean duration of ovarian stimulation and mean amount of gonadotropins in
OCP pretreated group was significantly higher than that of no pretreatment group (11.7 ±
2.3 vs. 9.8 ± 1.8 days and 2720.4 ± 1165.0 IU vs. 2295.8 ± 1121.1 IU). The mean number
of retrieved oocytes and oocyte maturation rate was significantly higher in OCP pretreated group (10.9 ± 5.3 vs. 7.5 ± 5.2 and 90.8% vs. 73.3%). The number of total gained
embryos and the good quality embryo rate was also significantly higher in OCP pretreated
group (7.9 ± 0.9 vs. 4.2 ± 1.0 and 69.9 % vs. 48.7%). Fertilization rate was also higher
in OCP pretreated group (84.9 ± 0.2% vs. 70.5 ± 0.3%). The implantation and pregnancy
rate were higher, although not reaching statistically significant level, in OCP pretreated
group (11.6% vs. 10.7% and 45.4% vs. 36.2%).
Conclusion: OCP pretreatment before GnRH antagonist protocol for IVF appears to have
reliable benefits in terms of IVF outcomes regarding number of retrieved oocytes, oocyte
maturation rate, fertilization rate, and good quality embryo rate. But, it also has a weak
point in respect to longer stimulation duration and increased gonadotropin consumption.
The OCP pretreated cycle in GnRH antagonist protocol is more advantageous, despite
not reaching statistical significant level, in respect to pregnancy rate, and cycle cancellation rate. Well controlled, large scaled studies are needed to support effectiveness of OCP
pretreatment before starting GnRH antagonist ovarian stimulation protocol for IVF/ICSI.