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Open Access Highly Accessed Research

Cycle scheduling for in vitro fertilization with oral contraceptive pills versus oral estradiol valerate: a randomized, controlled trial

Erik E Hauzman1, Azucena Zapata1, Alfonso Bermejo1, Carlos Iglesias1, Antonio Pellicer23 and Juan A Garcia-Velasco14*

Author Affiliations

1 IVI Madrid, Avda del Talgo, 68-70, 28023 Madrid, Spain

2 IVI Valencia, Plaza de la Policía Local, 3, 46015 Valencia, Spain

3 Universidad de Valencia, Avda de Blasco Ibáñez, 13, 46010 Valencia, Spain

4 Rey Juan Carlos University, Avda del Talgo 68-70, 28023 Madrid, Spain

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Reproductive Biology and Endocrinology 2013, 11:96  doi:10.1186/1477-7827-11-96

Published: 28 September 2013

Abstract

Background

Both oral contraceptive pills (OCPs) and estradiol (E2) valerate have been used to schedule gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles and, consequently, laboratory activities. However, there are no studies comparing treatment outcomes directly between these two pretreatment methods. This randomized controlled trial was aimed at finding differences in ongoing pregnancy rates between GnRH antagonist IVF cycles scheduled with OCPs or E2 valerate.

Methods

Between January and May 2012, one hundred consecutive patients (nonobese, regularly cycling women 18–38 years with normal day 3 hormone levels and <3 previous IVF/ICSI attempts) undergoing IVF with the GnRH antagonist protocol were randomized to either the OCP or E2 pretreatment arms, with no restrictions such as blocking or stratification. Authors involved in data collection and analysis were blinded to group assignment. Fifty patients received OCP (30 μg ethinyl E2/150 μg levonorgestrel) for 12–16 days from day 1 or 2, and stimulation was started 5 days after stopping OCP. Similarly, 50 patients received 4 mg/day oral E2 valerate from day 20 for 5–12 days, until the day before starting stimulation.

Results

Pretreatment with OCP (mean±SD, 14.5±1.7 days) was significantly longer than with E2 (7.8±1.9 days). Stimulation and embryological characteristics were similar. Ongoing pregnancy rates (46.0% vs. 44.0%; risk difference, –2.0% [95% CI –21.2% to 17.3%]), as well as implantation (43.5% vs. 47.4%), clinical pregnancy (50.0% vs. 48.0%), clinical miscarriage (7.1% vs. 7.7%), and live birth (42.0% vs. 40.0%) rates were comparable between groups.

Conclusions

This is the first study to directly compare these two methods of cycle scheduling in GnRH antagonist cycles. Our results fail to show statistically significant differences in ongoing pregnancy rates between pretreatment with OCP and E2 for IVF with the GnRH antagonist protocol. Although the study is limited by its sample size, our results may contribute to a future meta-analysis. An interesting future direction would be to extend our study to women with decreased ovarian reserve, as these are the patients in whom an increase in oocyte yield—due to the hypothetical beneficial effect of steroid pretreatment on follicular synchronization—could more easily be demonstrated.

Trial registration

ClinicalTrials.gov http://NCT01501448 webcite.

Keywords:
IVF; GnRH antagonist; Cycle scheduling; Oral contraceptives; Estrogen pretreatment