Cycle scheduling for in vitro fertilization with oral contraceptive pills versus oral estradiol valerate: a randomized, controlled trial

Reproductive Biology and Endocrinology

Research

Azucena Zapata¹  Erik E Hauzman¹  Alfonso Bermejo¹  Carlos Iglesias¹  Juan A Garcia-Velasco²  Antonio Pellicer³ 

[1] IVI Madrid, Avda del Talgo, 68-70, 28023, Madrid, Spain;IVI Madrid, Avda del Talgo, 68-70, 28023, Madrid, Spain;Rey Juan Carlos University, Avda del Talgo 68-70, 28023, Madrid, Spain;IVI Valencia, Plaza de la Policía Local, 3, 46015, Valencia, Spain;Universidad de Valencia, Avda de Blasco Ibáñez, 13, 46010, Valencia, Spain;

关键词: IVF;    GnRH antagonist;    Cycle scheduling;    Oral contraceptives;    Estrogen pretreatment;   

DOI  :  10.1186/1477-7827-11-96

 received in 2013-08-03, accepted in 2013-09-24,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundBoth oral contraceptive pills (OCPs) and estradiol (E2) valerate have been used to schedule gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles and, consequently, laboratory activities. However, there are no studies comparing treatment outcomes directly between these two pretreatment methods. This randomized controlled trial was aimed at finding differences in ongoing pregnancy rates between GnRH antagonist IVF cycles scheduled with OCPs or E2 valerate.MethodsBetween January and May 2012, one hundred consecutive patients (nonobese, regularly cycling women 18–38 years with normal day 3 hormone levels and <3 previous IVF/ICSI attempts) undergoing IVF with the GnRH antagonist protocol were randomized to either the OCP or E2 pretreatment arms, with no restrictions such as blocking or stratification. Authors involved in data collection and analysis were blinded to group assignment. Fifty patients received OCP (30 μg ethinyl E2/150 μg levonorgestrel) for 12–16 days from day 1 or 2, and stimulation was started 5 days after stopping OCP. Similarly, 50 patients received 4 mg/day oral E2 valerate from day 20 for 5–12 days, until the day before starting stimulation.ResultsPretreatment with OCP (mean±SD, 14.5±1.7 days) was significantly longer than with E2 (7.8±1.9 days). Stimulation and embryological characteristics were similar. Ongoing pregnancy rates (46.0% vs. 44.0%; risk difference, –2.0% [95% CI –21.2% to 17.3%]), as well as implantation (43.5% vs. 47.4%), clinical pregnancy (50.0% vs. 48.0%), clinical miscarriage (7.1% vs. 7.7%), and live birth (42.0% vs. 40.0%) rates were comparable between groups.ConclusionsThis is the first study to directly compare these two methods of cycle scheduling in GnRH antagonist cycles. Our results fail to show statistically significant differences in ongoing pregnancy rates between pretreatment with OCP and E2 for IVF with the GnRH antagonist protocol. Although the study is limited by its sample size, our results may contribute to a future meta-analysis. An interesting future direction would be to extend our study to women with decreased ovarian reserve, as these are the patients in whom an increase in oocyte yield—due to the hypothetical beneficial effect of steroid pretreatment on follicular synchronization—could more easily be demonstrated.Trial registrationClinicalTrials.gov NCT01501448

【 授权许可】

Unknown   
© Hauzman et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.