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Hum. Reprod. Advance Access published online on September 15, 2006
Human Reproduction, doi:10.1093/humrep/del369
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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 June 9, 2006
Revised August 4, 2006
Accepted August 21, 2006

Article

Does meloxicam increase the incidence of anovulation induced by single administration of levonorgestrel in emergency contraception? A pilot study

M.R. Massai 1 *, M.L. Forcelledo 1, V. Brache 2, A.S. Tejada 2, A.M. Salvatierra 1, M.V. Reyes 1, F. Alvarez 2, A. Faúndes 2, and H.B. Croxatto 1

1 Instituto Chileno de Medicina Reproductiva (ICMER), Santiago, Chile
2 PROFAMILIA, Santo Domingo, Dominican Republic

* To whom correspondence should be addressed.
M.R. Massai, E-mail: rmassai{at}icmer.org


  Abstract

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.

Keywords: cyclooxygenase-2 inhibitor/emergency contraception/levonorgestrel/meloxicam/ovulation.
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