Pretreatment with an oral contraceptive reduces the incidence of functional ovarian cyst formation during pituitary suppression by gonadotropins releasing hormone agonists and reduces the time required to achieve pituitary suppression

ABSTRACT

To assess the effect of pretreatment with combined oral contraceptive pills on ovarian cyst formation during pituitary suppression with buserelin acetate. Prospective study. Seventy six patients [76] who were undergoing IVF ET treatment. Patients in the study group [39] were pretreated with a combined oral contraceptive [OC] for 14 days starting on the second day of menstruation. The administration of buserelin acetate was initiated following the last day of OC administration. Patients in the control group [37] began to receive buserelin acetate on day 2 of menstruation. Ultrasound scans and hormonal assays were performed on the first day of menstruation, 7days after the commencement of buserelin acetate administration and every 4 days thereafter until pituitary suppression was achieved. After 7 days of GnRH-a administration, cysts were found in 3 patients in the study group compared to 12 cases in the control group. These numbers decreased to 1 and 7 cases after 14 days of agonist use. Three cases in the control group required surgical aspiration as the cysts persisted for 21 days after agonist use. Patients in the study group required a significantly shorter period of GnRH-a administration [12.6 days] [range 8-16 days] compared to [16.3 days] [range 11-21 days] in the control group. Days of gonadotropins stimulation and total number of ampoules required to achieve follicular response were significantly less in the study group [10.2 days and 41.2 ampoules] compared to [13.2 days and 53.2 ampoules] in the control group. Patients who were pretreated with the OC achieved marginally higher E2 levels on the day of hCG administration, 1,636 [1,166-3,311] compared to 1,538 [965-2,200] pmol/L in the control group. The patients in the study group produced higher numbers of developed follicles [10.2 versus 9.2], oocytes collected [9.4 versus 8.5], fertilization rate, [80.2% versus 78.2%] and number of good embryos available for transfer [6.3 versus 6.1] but the difference was not significant. Pretreatment with an OC abolishes ovarian cyst formation, shortens the time required to achieve pituitary suppression, and decreases gonadotropins requirements without having a negative effect on pregnancy rates