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Hum. Reprod. Advance Access published online on August 26, 2006
Human Reproduction, doi:10.1093/humrep/del340
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received April 3, 2006
Revised June 26, 2006
Accepted July 27, 2006

Article

Effects of oral contraceptive, synthetic progestogen or natural estrogen pre-treatments on the hormonal profile and the antral follicle cohort before GnRH antagonist protocol

I. Cédrin-Durnerin 1 *, B. Bständig 2, I. Parneix 3, V. Bied-Damon 4, C. Avril 5, C. Decanter 6, and J.N. Hugues 1

1 Service de Médecine de la Reproduction, Hôpital Jean Verdier, Assistance Publique--Hôpitaux de Paris, Université Paris XIII, Bondy
2 Hôpital de l’Archet, Nice
3 Clinique Jean Villar, Aquitaine santé--Médecine de la Reproduction, Bruges
4 Clinique Monplaisir, Lyon
5 Clinique St Antoine, Bois Guillaume
6 Hôpital Jeanne De Flandre, Lille, France

* To whom correspondence should be addressed.
I. Cédrin-Durnerin, E-mail: isabelle.cedrin-durnerin{at}jvr.ap-hop-paris.fr


  Abstract

BACKGROUND: Steroid pre-treatments may be useful to program GnRH antagonist IVF/ICSI cycles. This prospective study assessed hormonal and ultrasound data collected during the free period after the discontinuation of three different pre-treatments to provide information on the optimal time interval required before starting stimulation. METHODS: Women were randomized to receive oral contraceptive pill (OCP) [ethinyl estradiol (E2) 30 µg + desogestrel 150 µg] (n = 21) or norethisterone 10 mg/day (n = 23) or 17-{beta}E2 4 mg/day (n = 25) or no pre-treatment (n = 24) for one cycle before IVF. Assessments were performed on post-treatment day (PD) 1, 3 and 5, or on spontaneous cycle day (CD) 1 and 3. RESULTS: After OCP and progestogen administration, FSH and LH concentrations shifted from strongly suppressed PD1 levels to PD5 values similar to those observed on CD1. Meanwhile, follicle sizes remained small up to PD5. In contrast, estrogen pre-treatment poorly reduced FSH levels on PD1 compared with OCP or progestogen. Consequently, follicle size was more heterogeneous. FSH rebound was maximal on PD3, whereas LH levels were slightly increased up to PD5. CONCLUSIONS: A 5-day free interval after OCP or progestogen offers the advantages of gonadotrophin recovery and homogeneous follicular cohort, whereas early FSH rebound occurring after estrogen pre-treatment argues for a short free period.

Keywords: GnRH antagonist/natural estrogen/oral contraceptive pill/pre-treatment/progestogen.
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