kjog Korean Journal of Obstetrics & Gynecology Korean J Obstet Gynecol 2233-5188 2233-5196 Korean Society of Obstetrics and Gynecology 10.5468/KJOG.2011.54.10.599 kjog-54-599 Original Article ORAL CONTRACEPTIVE PILL PRETREATMENT IN OVARIAN STIMULATION WITH GnRH ANTAGONISTS FOR IN VITRO FERTILIZATION: A COMPARATIVE STUDY Choo Youn-Sil MD Han Ae-Ra MD Yang Seung-Heon MD Sung Na-Young MD Cha Sun-Hwa MD Kim Hye-Ok MD Park Chan-Woo MD Song In-Ok MD Koong Mi-Kyoung MD Kang In-Soo MD Yang Kwang-Moon MD Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea Corresponding author: Kwang-Moon Yang, MD Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul 100-380, Korea Tel: +82-2-2000-4728 Fax: +82-2-2000-7790 E-mail: kmlyang@naver.com 12011 2112011 5410 599604 15052011 16082011 22082011 Copyright © 2011 Korean Society of Obstetrics and Gynecology 2011 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objective

To evaluate whether oral contraceptive pill (OCP) pretreatments in gonadotropin-releasing hormone (GnRH) antagonist ovarian stimulation protocols takes positive effects on in vitro fertilization (IVF) outcomes in respect to retrieved oocyte number, oocyte maturation rate, fertilization rate, good quality embryo rate, cycle cancellation rate, pregnancy rate and clinical abortion rate.

 Methods

A total of 194 cycles using GnRH antagonist protocol was performed at infertility clinic of our institute from September 1st, 2009 to February 28th, 2010. The medical records of GnRH antagonist protocols for IVF with or without OCP pretreatment in our IVF unit were retrospectively analyzed. We compared the IVF outcomes between OCP pretreated (n=41) and no pretreatment group (n=153).

 Results

In cycles with OCP pretreated group, the total used dosage of gonadotropin (3019.38±1379.00 IU) were higher than that of no pretreatment group (2551.52 ± 1157.05 IU, P = 0.054). The duration of ovarian stimulation in OCP pretreated group (11.5 ± 2.0) was significantly longer than that of control group (9.5 ± 1.9, P = 0.000). The number of gained total embryo (2.8±0.9 vs. 2.5±1.0, P = 0.055) and fertilization rate (77.2% vs. 65.5%, P = 0.017) were significantly higher in OCP pretreated group. There is no significant difference in pregnancy rate between two groups (39.4% vs. 30.0%, P = 0.304).

 Conclusion

OCP pretreatment before GnRH antagonist protocol for IVF appears not to have reliable benefit in terms of IVF outcomes. Well-controlled and large-scaled studies are needed.

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Histogram of IVF outcomes of GnRH antagonist protocol with or without OCP pretreatment. IVF, in vitro fertilization; GnRH, gonadotropin-releasing hormone; OCP, oral contraceptive pill; COH, controlled ovarian hyperstimulation. aStatistically significant (P-value < 0.05). bP-value = 0.055.

Comparison of baseline characteristics and ART outcomes

  OCP pretreated group (n = 41) No pretreatment group (n = 153) P-value
Age of female (yr) 35.8 ± 3.1 36.8 ± 3.5 NS
Age of husband (yr) 36.9 ± 4.0 38.3 ± 4.0 0.039
BMI (kg/m2) 21.1 ± 2.4 20.5 ± 1.9 NS
Basal serum FSH (mIU/mL) 9.9 ± 4.0 10.5 ± 2.1 NS
Primary infertility (%) 65.9 55.6 NS
Duration of infertility (mon.) 49.7 ± 33.3 52.4 ± 40.2 NS
Dosage of gonadotropin (IU) 3019.4 ± 1379.0 2551.5 ± 1157.1 0.054
Duration of COH (day) 11.5 ± 2.1 9.5 ± 1.9 0.000a
E2 on hCG day (pg/mL) 1170.8 ± 1267.3 1086.0 ± 877.5 NS
EM thickness on hCG day (mm) 10.4 ± 2.6 10.0 ± 2.4 NS
Number of retrieved oocyte 7.2 ± 5.1 7.0 ± 5.2 NS
Number of matured oocyte 5.6 ± 4.3 5.1 ± 4.1 NS
Oocyte maturation rate (%) 81.1 75.1 NS
Number of total gained embryo 2.8 ± 0.9 2.5 ± 1.0 0.055
Good quality embryo rate (%) 26.8 19.1 NS
Number of transferred embryo 2.6 ± 0.9 2.3 ± 1.0 NS
Implantation rate (%) 10.6 10.5 NS
Fertilization rate (%) 77.2 ± 0.2 65.5 ± 0.3 0.017a
ICSI rate (%) 75.8 83.1 NS
Cycle cancellation rate (%) 19.5 14.5 0.468
Pregnancy rate/embryo transfer (%) 39.4 30.0 0.304
Clinical abortion rate (%) 41.7 42.1 1.000

Values are presented as mean ± standard deviation. ART, assisted reproductive technology; OCP, oral contraceptive pill; NS, not statistically significant; BMI, body mass index; FSH, follicle stimulating hormone; COH, controlled ovarian hyperstimulation; E2, estradiol;EM, endometrial thickness; hCG, human chorionic gonadotropin; ICSI, intracytoplasmic sperm injection.

Statistically significant (P-value < 0.05).