Pregnancy & Baby Index: Fertility and Conception: Research: Oral contraceptive use may be good for IVF patients

Oral contraceptive use may be good for IVF patients

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Pre-treating fertility patients with oral contraceptives allows for a treatment regimen which includes fewer fertility drug injections and offers flexibility for egg retrieval, according to a study released in October 2003 at the American Society for Reproductive Medicine's (ASRM) Annual Meeting.

Increase in egg production

When the oral contraceptive regimen was followed by treatment with Follistim® (follitropin beta) and Antagon (ganirelix acetate), 78 percent of participant egg retrievals were scheduled during a five-day period. However, by altering the start date and discontinuation of the contraceptive pill by one day, the number of weekday retrievals increased to 89 percent.

"Currently, it is very difficult for physicians to predict the exact point during a woman's treatment cycle when her eggs will be fully mature and ready for retrieval," says Larry I. Barmat, MD, of Abington Reproductive Medicine, Abington, Pennsylvania. "By pre-treating patients with oral contraceptive pills, physicians can more accurately schedule egg retrievals during a five-day work week. This allows treatment to be more patient-friendly, while at the same time not leaving the date of egg retrieval up to chance."

The study compared the clinical and endocrine outcomes of in vitro fertilization (IVF) patients undergoing treatments with recombinant follicle stimulating hormone (rFSH) and a gonadotropin-releasing hormone (GnRH). The rFSH first stimulates a woman's follicles to produce eggs, and the GnRH then causes the mature follicles to release the egg into the fallopian tube where it can be retrieved for fertilization.

Of the 80 patients who participated in the study, 39 were chosen at random to receive the standard rFSH/GnRH antagonist (Antagon) protocol while 41 were pre-treated with rFSH/GnRH agonists (Lupron®, leuprolide acetate). The study group was pre-treated with contraceptive pills (Desogen®, desogestrel and ethinyl estradiol) to measure the ability to facilitate cycle scheduling, control patient response to treatment, and reduce the incidence of a premature surge of luteinizing hormone (a progesterone hormone that stimulates the final maturing of follicles before releasing eggs).

All participants began the oral contraceptives on day two to four of their cycle, and discontinued on a Sunday after days 14 to 28 of treatment. Evening doses of 300IU/day of Follistim began Friday (the fifth day after the patients stopped taking the contraceptive pill) and were adjusted at doses 75 to 150 IU, based on patient response. The hCG (human chorionic gonadotropin, which helps induce ovulation) was administered to the women when two or more follicles reached 16 -18 mm in diameter. Luteal support (which helps prepare the uterine lining for implantation) was provided according to individual clinic protocols.

The oocytes were retrieved 35 to 36 hours later, and the embryos transferred on day two, three, or five.

The antagonist group received an evening dose of 250 µg/day when the lead follicle reached an average diameter of 12 to 14 mm. The agonist group had a five-day overlap with the oral contraceptives at .5 mg/day and decreased to .25 mg/day.

Patient outcomes were similar in the number of fertilized eggs retrieved, embryos transferred and implanted, and ongoing pregnancy rates. Of the participants who received Lupron®, there was a 90 percent egg retrieval rate during the five day-work week. Only three patients cancelled participation from the antagonist group and one from the agonist group.

Patients were equally recruited from four study centers, including Abington, Presbyterian Hospital of Dallas, Carolinas Medical Center and the Fertility Institute of New Orleans. Clinical pregnancy was confirmed with serum B-hCG and ultrasound.