Cycle scheduling with oral contraceptive pills in the GnRH antagonist protocol vs the long protocol: a randomized, controlled trial

Objective: To compare cycle outcomes after scheduling with the standard long protocol versus the use of oral contraceptive pills (OCPs) in patients undergoing GnRH antagonist cycles. Design: Prospective, randomized, controlled trial. Setting: University-affiliated private assisted reproduction center. Patient(s): Regularly cycling women aged 38 years with fewer than three previous IVF attempts were enrolled. Previous low responses to controlled ovarian hyperstimulation, ovarian surgery, or polycystic ovary were exclusion criteria. Intervention(s): One hundred fifteen patients received OCP (0.030 ethinyl E-2/0.15 desogestrel) for 12-16 days, and controlled ovarian hyperstimulation was started on day 5 after OCP treatment; similarly, 113 patients received the long protocol from day 20-22 of the previous cycle. Main Outcome Measure(s): The primary outcome was ongoing pregnancy rate; secondary outcome variables were clinical pregnancy rate, live birth rate, implantation rate, and miscarriage rate. Result(s): Patients receiving the GnRH antagonist treatment showed a lower peak serum E-2 (1,334 vs. 1,823 pg/mL) but similar peak serum PE (0.58 vs. 0.65 ng/mL), lower duration of the stimulation (10.3 vs. 11.4 days) with similar FSH consumption ( 1,613 vs. 1,807 IU), and ovarian response (10.2 vs. 11.7 oocytes). No differences were observed in the fertilization rates (68.1% vs. 64.8%), total number of embryos obtained (5.9 vs. 6.2), mean number of embryos transferred (1.8 vs. 1.8), implantation rate (36% vs. 39%), miscarriage rate (8.9% vs. 17%), ongoing pregnancy rate (47.8% vs. 53.9%), or live birth rate (44.3% vs. 47%). Conclusion(s): Comparable outcomes can be obtained using OCP containing 0.030 ethinyl E-2/0.15 desogestrel to schedule patients undergoing the antagonist protocol. (Fertil Steril (R) 2011;96:590-3. (C) 2011 by American Society for Reproductive Medicine.)