Hum. Reprod. Advance Access originally published online on October 27, 2005
Human Reproduction 2006 21(1):95-103; doi:10.1093/humrep/dei302
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A comparative randomized trial to assess the impact of oral contraceptive pretreatment on follicular growth and hormone profiles in GnRH antagonist-treated patients
1 Monash IVF and Department of Obstetrics and Gynecology, Monash University, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168 and 2 Research Centre for Reproductive Health and Repromed, University of Adelaide, The Queen Elizabeth Hospital, First Floor, Maternity Building, 28 Woodville Road, Woodville, SA 5011, Australia
3 To whom correspondence should be addressed. E-mail: lukrombauts{at}hotmail.com
BACKGROUND: This randomized controlled trial was designed to assess the impact of oral contraceptive (OC) scheduling with a GnRH antagonist (ganirelix) regimen on the ovarian response of women undergoing recombinant FSH (rFSH) stimulation for IVF, compared with a non-scheduled ganirelix regimen and a long GnRH agonist (nafarelin) protocol. METHODS: A total of 110 women was treated with an OC and ganirelix, 111 with ganirelix alone and 111 with nafarelin. The OC (containing 30 µg ethinylestradiol/150 µg desogestrel) was taken for 14–28 days and stopped 2 days prior to the start of rFSH treatment. Primary efficiency parameters were the number of cumulus-oocyte complexes (per attempt) and the number of grade 1 or 2 embryos (per attempt). RESULTS: In terms of follicular growth and hormone profiles, the OC-scheduled antagonist regimen mimicked the agonist regimen rather than the (non-scheduled) GnRH antagonist regimen. In the OC-scheduled GnRH antagonist group and the nafarelin group (versus the non-scheduled antagonist group), pituitary suppression was more profound at the start of stimulation (P # 0.001), there was a slower start of follicular growth (P # 0.001), longer stimulation was required (11.7 and 10.3 days respectively versus 9.4; P # 0.001), and more rFSH was used (2667 and 2222 IU versus 1966 IU; P # 0.001). In the three groups, the number of oocytes was similar (13.1, 12.9 and 11.5 respectively; not significant) as well as the number of good quality embryos (5.1, 5.7 and 5.0 respectively; not significant). CONCLUSION: OC treatment prior to the rFSH/ganirelix regimen can be successfully applied to schedule patients, although more days of stimulation and more rFSH are required than with a non-scheduled GnRH antagonist regimen.
Key words: GnRH agonist/antagonist/ganirelix/IVF/nafarelin/oral contraceptive pretreatment
* The Orgalutran® Scheduling Study Group: A.Speirs (Melbourne IVF, Melbourne, Australia), D.Healy and L.Rombauts (Monash IVF, Melbourne, Australia), B.Watkins (Tasmania IVF, Hobart, Australia), J.Yovich (Pivet Medical Centre, Perth, Australia), R.Norman (Research Centre for Reproductive Health and Repromed, University of Adelaide, Adelaide, Australia), M.Bowman (Sydney IVF, Sydney, Australia), G.Driscoll (City West IVF, Sydney, Australia), S.Lindenberg (Herlev, Denmark), Z.Kilani (Zahran Amman, Jordan), P.O.Dale (Oslo, Norway), B.J.Oddens [Organon (Australia) Pty Limited, Sydney, Australia], H.G.van Hooren and B.M.J.L.Mannaerts (Organon International, Oss, The Netherlands).
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