Abstract
Purpose
To evaluate if the degree of recovery of serum gonadotropins after oral contraceptive pills (OCP) pretreatment has an impact on ovarian response in GnRH-antagonist IVF cycles in women of advanced maternal age.
Methods
In this retrospective cohort study, we included 98 women 35–42 years undergoing their first IVF cycle receiving gonadotropins and a fixed GnRH-antagonist adjuvant protocol. Data analysis was carried out according to changes in serum FSH, LH and estradiol (E2) levels (basal and post-OCP) divided in quartiles, and also according to absolute levels. The main outcomes were peak serum E2, number of mature oocytes retrieved, length of stimulation, and amount of gonadotropins used.
Results
By quartile analysis, patients with the highest levels of serum gonadotropins suppression and also patients with gonadotropin rebound needed larger amounts of LH during the treatment. On the other hand, women with absolute suppression of FSH/LH had increased length of stimulation.
Conclusions
The results of this study provide data that assist in clinical management. Gonadotropin serum levels after OCP treatment provide information for optimization of supplementation with LH in GnRH-antagonist cycles in women over age 35.
Similar content being viewed by others
References
Acevedo B, Sanchez M, Gomez JL, Cuadros J, Ricciarelli E, Hernandez ER. Luteinizing hormone supplementation increases pregnancy rates in gonadotropin-releasing hormone antagonist donor cycles. Fertil Steril. 2004;82:343–7.
Al-Inany HG, Youssef MA, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, Abou-Setta AM. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2011;CD001750.
Arslan M, Bocca S, Mirkin S, Barroso G, Stadtmauer L, Oehninger S. Controlled ovarian hyperstimulation protocols for in vitro fertilization: two decades of experience after the birth of Elizabeth Carr. Fertil Steril. 2005;84:555–69.
Barroso G, Oehninger S, Monzo A, Kolm P, Gibbons WE, Muasher SJ. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet. 2001;18:499–505.
Bjercke S, Fedorcsak P, Abyholm T, Storeng R, Ertzeid G, Oldereid N, Omland A, Tanbo T. IVF/ICSI outcome and serum LH concentration on day 1 of ovarian stimulation with recombinant FSH under pituitary suppression. Hum Reprod. 2005;20:2441–7.
Cai QF, Wan F, Huang R, Zhang HW. Factors predicting the cumulative outcome of IVF/ICSI treatment: a multivariable analysis of 2450 patients. Hum Reprod. 2011;26:2532–40.
Cedrin-Durnerin I, Bstandig B, Parneix I, Bied-Damon V, Avril C, Decanter C, Hugues JN. Effects of oral contraceptive, synthetic progestogen or natural estrogen pre-treatments on the hormonal profile and the antral follicle cohort before GnRH antagonist protocol. Hum Reprod. 2007;22:109–16.
Centers for Disease Control and Prevention. 2009 Assisted Reproductive Technology and Success Rates. National Summary and Fertility Clinic Reports 2007.
Devroey P, Aboulghar M, Garcia-Velasco J, Griesinger G, Humaidan P, Kolibianakis E, Ledger W, Tomas C, Fauser BC. Improving the patient’s experience of IVF/ICSI: a proposal for an ovarian stimulation protocol with GnRH antagonist co-treatment. Hum Reprod. 2009;24:764–74.
Dowling-Lacey D, Jones E, Mayer J, Bocca S, Stadtmauer L, Oehninger S. Elective transfer of two embryos: reduction of multiple gestations while maintaining high pregnancy rates. J Assist Reprod Genet. 2007;24:11–5.
Gonen Y, Jacobson W, Casper RF. Gonadotropin suppression with oral contraceptives before in vitro fertilization. Fertil Steril. 1990;53:282–7.
Griesinger G, Shapiro DB, Kolibianakis EM, Witjes H, Mannaerts BM. No association between endogenous LH and pregnancy in a GnRH antagonist protocol: part II, recombinant FSH. Reprod Biomed Online. 2011;23:457–65.
Huirne JA, Homburg R, Lambalk CB. Are GnRH antagonists comparable to agonists for use in IVF? Hum Reprod. 2007;22:2805–13.
Kim CH, Jeon GH, Cheon YP, Jeon I, Kim SH, Chae HD, Kang BM. Comparison of GnRH antagonist protocol with or without oral contraceptive pill pretreatment and GnRH agonist low-dose long protocol in low responders undergoing IVF/intracytoplasmic sperm injection. Fertil Steril. 2009;92:1758–60.
Klein NA, Battaglia DE, Fujimoto VY, Davis GS, Bremner WJ, Soules MR. Reproductive aging: accelerated ovarian follicular development associated with a monotropic follicle-stimulating hormone rise in normal older women. J Clin Endocrinol Metab. 1996;81:1038–45.
Kolibianakis EM, Papanikolaou EG, Camus M, Tournaye H, Van Steirteghem AC, Devroey P. Effect of oral contraceptive pill pretreatment on ongoing pregnancy rates in patients stimulated with GnRH antagonists and recombinant FSH for IVF. A randomized controlled trial. Hum Reprod. 2006;21:352–7.
Kolibianakis EM, Venetis CA, Kalogeropoulou L, Papanikolaou E, Tarlatzis BC. Fixed versus flexible gonadotropin-releasing hormone antagonist administration in in vitro fertilization: a randomized controlled trial. Fertil Steril. 2011;95:558–62.
Kolibianakis EM, Zikopoulos K, Schiettecatte J, Smitz J, Tournaye H, Camus M, Van Steirteghem AC, Devroey P. Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF. Hum Reprod. 2004;19:2490–6.
Mahutte NG, Arici A. Role of gonadotropin-releasing hormone antagonists in poor responders. Fertil Steril. 2007;87:241–9.
Meldrum DR, Schoolcraft W. Microdose flare versus antagonist for poor responders. Fertil Steril. 2010;93:e35. author reply e36.
Meldrum DR, Scott Jr RT, Levy MJ, Alper MM, Noyes N. Oral contraceptive pretreatment in women undergoing controlled ovarian stimulation in ganirelix acetate cycles may, for a subset of patients, be associated with low serum luteinizing hormone levels, reduced ovarian response to gonadotropins, and early pregnancy loss. Fertil Steril. 2009;91:1963–5.
Mochtar MH, Van der V, Ziech M, van Wely M. Recombinant Luteinizing Hormone (rLH) for controlled ovarian hyperstimulation in assisted reproductive cycles. Cochrane Database Syst Rev. 2007;CD005070.
Murphy MF, Campbell MJ, Bone M. Is there an increased risk of twinning after discontinuation of the oral contraceptive pill? J Epidemiol Commun Health. 1989;43:275–9.
Neal-Perry G, Nejat E, Dicken C. The neuroendocrine physiology of female reproductive aging: An update. Maturitas. 2010;67:34–8.
Oehninger S. Ovulation induction in IVF. Minerva Ginecol. 2011;63:137–56.
Pandian Z, McTavish AR, Aucott L, Hamilton MP, Bhattacharya S. Interventions for ‘poor responders’ to controlled ovarian hyper stimulation (COH) in in-vitro fertilisation (IVF). Cochrane Database Syst Rev. 2010;CD004379.
Rombauts L, Healy D, Norman RJ. A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients. Hum Reprod. 2006;21:95–103.
Scott RT, Toner JP, Muasher SJ, Oehninger S, Robinson S, Rosenwaks Z. Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome. Fertil Steril. 1989;51:651–4.
Smulders B, van Oirschot SM, Farquhar C, Rombauts L, Kremer JA. Oral contraceptive pill, progestogen or estrogen pre-treatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques. Cochrane Database Syst Rev. 2010;CD006109.
The European Recombinant Human LH Study Group. Recombinant human luteinizing hormone (LH) to support recombinant human follicle-stimulating hormone (FSH)-induced follicular development in LH- and FSH-deficient anovulatory women: a dose-finding study. J Clin Endocrinol Metab. 1998;83(5):1507–14.
van Heusden AM, Fauser BC. Activity of the pituitary-ovarian axis in the pill-free interval during use of low-dose combined oral contraceptives. Contraception. 1999;59:237–43.
Veeck LL. Extracorporeal maturation: Norfolk, 1984. Ann N Y Acad Sci. 1985;442:357–67.
Author information
Authors and Affiliations
Corresponding author
Additional information
Capsule
Variable changes in serum gonadotropin levels after OCP affect outcomes of GnRH-antagonist treated IVF/ICSI cycles
Rights and permissions
About this article
Cite this article
Schmitz, C., Bocca, S., Beydoun, H. et al. Does the degree of hypothalamic-pituitary-ovarian recovery after oral contraceptive pills affect outcomes of IVF/ICSI cycles receiving GnRH-antagonist adjuvant therapy in women over 35 years of age?. J Assist Reprod Genet 29, 877–882 (2012). https://doi.org/10.1007/s10815-012-9812-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10815-012-9812-0