Hum. Reprod. Advance Access originally published online on September 15, 2006
Human Reproduction 2007 22(2):434-439; doi:10.1093/humrep/del369
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Does meloxicam increase the incidence of anovulation induced by single administration of levonorgestrel in emergency contraception? A pilot study
1 Instituto Chileno de Medicina Reproductiva (ICMER), Santiago, Chile and 2 PROFAMILIA, Santo Domingo, Dominican Republic
3 To whom correspondence should be addressed at: Instituto Chileno de Medicina Reproductiva (ICMER), J.V. Lastarria 29, Depto. 101, Santiago, Chile. E-mail: rmassai{at}icmer.org
BACKGROUND: Levonorgestrel (LNG) consistently prevents follicular rupture only when it is given before the onset of the ovulatory stimulus. As locally synthesized prostaglandin (PG) plays a crucial role in follicular rupture and cyclooxygenase-2 (cox-2) catalyses the final step of PG synthesis, we reasoned that adding a cox-2 inhibitor to LNG would prevent follicular rupture even after the ovulatory process had been triggered by the gonadotrophin surge. METHODS: Forty-one women were divided into two groups. One was treated when the size of the leading follicle was 15–17 mm (n = 10) and the other when it was 
18 mm (n = 31). Each woman contributed with one cycle treated with LNG 1.5 mg single dose plus placebo and another treated with LNG + meloxicam (Melox) 15 mg, in a randomized order. Serial blood sampling for the assay of LH and follicular monitoring by transvaginal ultrasound were performed before and after treatment. RESULTS: Follicular rupture failed to occur within the 5-day period that followed treatment in 50 and 70% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the 15–17 mm group (P = 0.15) and in 16 and 39% of cycles treated with LNG + Placebo and LNG + Melox, respectively, in the 18 mm group (P < 0.052). The overall proportion of cycles with no follicular rupture or ovulatory dysfunction increased significantly by the addition of Melox to LNG (66 versus 88%, P < 0.012; n = 41-matched pairs). CONCLUSIONS: The trend towards increased incidence of no follicular rupture when Melox was combined with LNG suggests that the addition of a cox-2 inhibitor has the potential to improve the contraceptive efficacy of LNG by a pre-fertilization effect.
Key words: cyclooxygenase-2 inhibitor/emergency contraception/levonorgestrel/meloxicam/ovulation
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  C. Jesam, A. M. Salvatierra, J. L. Schwartz, and H. B. Croxatto Suppression of follicular rupture with meloxicam, a cyclooxygenase-2 inhibitor: potential for emergency contraception Hum. Reprod., November 19, 2009; (2009) dep392v1. [Abstract] [Full Text] [PDF]
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