Oral contraceptive pill pretreatment in ovarian stimulation with GnRH antagonists for IVF: a systematic review and meta-analysis

Griesinger, George; Venetis, Christos A.; Marx, Tanja; Diedrich, Klaus; Tarlatzis, Basil C.; Kolibianakis, Efstratios M.

doi:10.1016/j.fertnstert.2007.07.1354

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Volume 90, Issue 4 , Pages 1055-1063, October 2008

Oral contraceptive pill pretreatment in ovarian stimulation with GnRH antagonists for IVF: a systematic review and meta-analysis

George Griesinger, M.D.
- Department of Obstetrics and Gynecology, University Clinic of Schleswig–Holstein, Campus Luebeck, Luebeck, Germany
- Reprint requests: George Griesinger, M.D., University Clinic of Schleswig–Holstein, Campus Luebeck, Department of Obstetrics and Gynecology, Ratzeburger Allee 160, 23538 Luebeck, Germany (FAX: +49 451 500 2170).
Christos A. Venetis, M.D.
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Tanja Marx
- Department of Obstetrics and Gynecology, University Clinic of Schleswig–Holstein, Campus Luebeck, Luebeck, Germany
Klaus Diedrich, M.D., Ph.D.
- Department of Obstetrics and Gynecology, University Clinic of Schleswig–Holstein, Campus Luebeck, Luebeck, Germany
Basil C. Tarlatzis, M.D., Ph.D.
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Efstratios M. Kolibianakis, M.D., Ph.D.
- Unit for Human Reproduction, 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece

Received 11 July 2007; received in revised form 23 July 2007; accepted 23 July 2007. published online 29 November 2007.

Objective

To assess the impact of oral contraceptive pill (OCP) pretreatment in ovarian stimulation for in vitro fertilization (IVF) using gonadotropin releasing hormone (GnRH) antagonists.

Design

Systematic review and meta-analysis of randomized controlled trials (RTC).

Setting

University IVF center.

Patient(s)

Infertile patients (n = 847), treated in four trials.

Intervention(s)

Systematic literature search (MEDLINE, EMBASE, CENTRAL COCHRANE, conference proceedings, reference lists) for randomized trials on OCP treatment before stimulation with gonadotropins and GnRH antagonist for IVF. Meta-analysis of data yielding pooled odds ratios (OR) or weighted differences of the means (WMD) and 95% confidence intervals (CI).

Main Outcome Measure(s)

Ongoing pregnancy rate per randomized woman.

Result(s)

Ongoing pregnancy rate per randomized woman was not found to be significantly different between patients with and those without OCP pretreatment (OR: 0.74, 95% CI: 0.53 to 1.03). Duration of gonadotropin stimulation (WMD: +1.41 days, 95% CI: +1.13 to +1.68) and gonadotropin consumption (WMD: +542 IU, 95% CI: +127 to +956) were significantly increased after OCP pretreatment. No significant differences were observed regarding the number of cumulus–oocyte complexes (COCs) and the fertilization rates.

Conclusion(s)

A significant difference in ongoing pregnancy rates between patients who received OCP pretreatment and those who did not is currently not present, although further studies are necessary for more solid conclusions on pregnancy likelihood to be drawn.

Key Words: GnRH antagonists, oral contraceptive pill, cetrorelix, ganirelix, antide