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Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in-vitro fertilization outcome in high responder patients.
Hum Reprod. 1997 Nov; 12(11):2359-65.HR

Abstract

Certain patients have a tendency for high response to gonadotrophin therapy which is often not ameliorated with prior gonadotrophin-releasing hormone agonist (GnRHa) suppression. As a result, these patients are frequently cancelled and often experience ovarian hyperstimulation syndrome (OHSS) episodes during in-vitro fertilization (IVF)-embryo transfer cycles. Patients with polycystic ovarian syndrome (PCOS) have been noted to be particularly sensitive to exogenous gonadotrophin therapy. We have developed a protocol which is effective in improving IVF outcome in high responder patients, including those with PCOS. Oral contraceptive pills (OCP) are taken for 25 days followed by s.c. leuprolide acetate, 1 mg/day, which is overlapped with the final 5 days of oral contraceptive administration. Low-dose gonadotrophin stimulation is then initiated on the third day of withdrawal bleeding in the form of either human menopausal gonadotrophins or purified urinary follicle-stimulating hormone at a dosage of 150 IU/day. Over a 5 year period, we reviewed our experience utilizing this dual method of suppression in 99 cycles obtained in 73 high responder patients. There were only 13 cancellations prior to embryo transfer (13.1%). The clinical and ongoing pregnancy rates per initiated cycle were 46.5 and 40.4% respectively. Only eight patients experienced mild-moderate OHSS following treatment. For those patients who had undergone previous IVF-embryo transfer cycles at our centre, significant improvements were noted in oocyte fertilization rates, embryo implantation rates and clinical/ongoing pregnancy rates with this protocol. Hormonal analyses revealed that the chief mechanism may be through an improved luteinizing hormone/follicle-stimulating hormone ratio following dual suppression. An additional feature of this dual method of suppression is significantly lower serum androgen concentrations, particularly dehydroepiandrosterone sulphate.

Authors+Show Affiliations

The Center for Reproductive Medicine and Infertility, The New York Hospital-Cornell Medical Center, New York 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9436663

Citation

Damario, M A., et al. "Dual Suppression With Oral Contraceptives and Gonadotrophin Releasing-hormone Agonists Improves In-vitro Fertilization Outcome in High Responder Patients." Human Reproduction (Oxford, England), vol. 12, no. 11, 1997, pp. 2359-65.
Damario MA, Barmat L, Liu HC, et al. Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in-vitro fertilization outcome in high responder patients. Hum Reprod. 1997;12(11):2359-65.
Damario, M. A., Barmat, L., Liu, H. C., Davis, O. K., & Rosenwaks, Z. (1997). Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in-vitro fertilization outcome in high responder patients. Human Reproduction (Oxford, England), 12(11), 2359-65.
Damario MA, et al. Dual Suppression With Oral Contraceptives and Gonadotrophin Releasing-hormone Agonists Improves In-vitro Fertilization Outcome in High Responder Patients. Hum Reprod. 1997;12(11):2359-65. PubMed PMID: 9436663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual suppression with oral contraceptives and gonadotrophin releasing-hormone agonists improves in-vitro fertilization outcome in high responder patients. AU - Damario,M A, AU - Barmat,L, AU - Liu,H C, AU - Davis,O K, AU - Rosenwaks,Z, PY - 1998/1/22/pubmed PY - 1998/1/22/medline PY - 1998/1/22/entrez KW - Americas KW - Biology KW - Clinical Research KW - Contraception KW - Contraceptive Methods--therapeutic use KW - Demographic Factors KW - Developed Countries KW - Endocrine System KW - Family Planning KW - Fertility KW - Fertility Measurements KW - Fertilization KW - Follicle Stimulating Hormone KW - Gonadotropins KW - Gonadotropins, Pituitary KW - Hormones KW - In Vitro KW - Infertility KW - Luteinizing Hormone KW - North America KW - Northern America KW - Oral Contraceptives--therapeutic use KW - Physiology KW - Population KW - Population Dynamics KW - Pregnancy Rate KW - Reproduction KW - Research Methodology KW - Research Report KW - Retrospective Studies KW - Studies KW - United States SP - 2359 EP - 65 JF - Human reproduction (Oxford, England) JO - Hum Reprod VL - 12 IS - 11 N2 - Certain patients have a tendency for high response to gonadotrophin therapy which is often not ameliorated with prior gonadotrophin-releasing hormone agonist (GnRHa) suppression. As a result, these patients are frequently cancelled and often experience ovarian hyperstimulation syndrome (OHSS) episodes during in-vitro fertilization (IVF)-embryo transfer cycles. Patients with polycystic ovarian syndrome (PCOS) have been noted to be particularly sensitive to exogenous gonadotrophin therapy. We have developed a protocol which is effective in improving IVF outcome in high responder patients, including those with PCOS. Oral contraceptive pills (OCP) are taken for 25 days followed by s.c. leuprolide acetate, 1 mg/day, which is overlapped with the final 5 days of oral contraceptive administration. Low-dose gonadotrophin stimulation is then initiated on the third day of withdrawal bleeding in the form of either human menopausal gonadotrophins or purified urinary follicle-stimulating hormone at a dosage of 150 IU/day. Over a 5 year period, we reviewed our experience utilizing this dual method of suppression in 99 cycles obtained in 73 high responder patients. There were only 13 cancellations prior to embryo transfer (13.1%). The clinical and ongoing pregnancy rates per initiated cycle were 46.5 and 40.4% respectively. Only eight patients experienced mild-moderate OHSS following treatment. For those patients who had undergone previous IVF-embryo transfer cycles at our centre, significant improvements were noted in oocyte fertilization rates, embryo implantation rates and clinical/ongoing pregnancy rates with this protocol. Hormonal analyses revealed that the chief mechanism may be through an improved luteinizing hormone/follicle-stimulating hormone ratio following dual suppression. An additional feature of this dual method of suppression is significantly lower serum androgen concentrations, particularly dehydroepiandrosterone sulphate. SN - 0268-1161 UR - https://www.unboundmedicine.com/medline/citation/9436663/Dual_suppression_with_oral_contraceptives_and_gonadotrophin_releasing_hormone_agonists_improves_in_vitro_fertilization_outcome_in_high_responder_patients_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/12.11.2359 DB - PRIME DP - Unbound Medicine ER -