Does Pretreatment with Progestogen or Oral Contraceptive Pills in Low Responders Followed by the GnRHa Flare Protocol Improve the Outcome of IVF-ET?

摘要

>Purpose: Women undergoing in vitro fertilization with lowovarian reserve and poor response to controlled ovarianhyperstimulation (COH) present a management dilemma.In a retrospective observational study, we compared thepretreatment use of the gestogen medroxyprogesterone acetate(10 mg twice daily from day 15 of the cycle for aminimum of 2 weeks) with an oral contraceptive pill (onetablet daily from day 4 of the cycle for a minimum of 3 weeks).>Methods: The criteria for inclusion in the study includedone or more of the following: abandoned cycles due topoor response, fewer than four oocytes retrieved followinga standard COH protocol, age >39 years, and elevatedbasal serum follicle-stimulating hormone (FSH).Thirty-eight women received pretreatment with gestogen, and asimilar number of women received pretreatment with thepill. The flare protocol was used in all treatment cyclescombined with an individualized dose of human menopausalgonadotropin (hMG) (4–8 ampoules/day of 75 units FSH/ampoule) depending on previous response, age, and earlyfollicular serum FSH level. Both groups were similar inmean age, duration of infertility, early follicular FSH levels,and the distribution of various aetiologies.>Results: Twenty-nine cycles were abandoned before oocyteretrieval, 15 (39.5%) in the pill group and 14 (36.8%) inthe gestogen group, because of an inadequate ovarianresponse. The mean (±SD) number of ampoules (75 IUFSH/ampoule) of hMG used per cycle was similar in thepill and gestogen groups (59.7 ± 19.3 vs. 70.2 ± 29.4,respectively). There also was no difference seen in the numbersof oocytes retrieved (4.4 ± 2.3 vs. 4.2 ± 2.5), totalnumber of embryos (2.5 ± 2.4 vs. 2.2 ± 1.1), or the numberof embryos transferred (1.8 ± 1.2 vs. 2.1 ± 1.0) in the pilland gestogen groups, respectively. One pregnancy in eachgroup resulted following embryo transfer in 22 women inthe pill group and in 24 women in the gestogen group.>Conclusions: We conclude that pre-IVF treatment with oralcontraceptive pill or gestogen combined with the flare protocolin women at high risk of or with a history of poor ovarianresponse, as defined in this study, did not appear to resultin an improvement in outcome of IVF-embryo transfer.