Comparison of FSH flare with and without pretreatment with oral contraceptive pills in poor responders undergoing in vitro fertilization

Objective

To compare FSH, LH, estrogen, and P flare response following 1 mg lupron injection in poor responders with or without pretreatment with oral contraceptive pills (OCPs).

Design

Prospective study.

Setting

University hospital.

Patient(s)

Poor responders undergoing IVF flare protocol from October 2002 to November 2003.

Intervention(s)

Patients were divided into group A, who received OCPs before IVF cycle (n = 12), and group B, who did not (n = 7). One milligram Lupron was injected SC after measuring day 2 serum FSH, LH, estrogen, and P. After 24 hours, serum hormones were measured before lupron administration.

Main outcome measure(s)

Serum FSH, LH, estrogen, and P before and after 1 mg lupron

Result(s)

Basal FSH was similar in both groups (8.6 ± 4.5 vs. 9.6 ± 2.9 mIU/mL). Group A patients had significantly lower day 2 FSH (3.6 ± 3.6 vs. 10.1 ± 4.2 mIU/mL; P<.05). After lupron, although both groups had a significant rise in FSH and LH, mean LH rise in group B was 39.5 ± 31 mIU/mL versus 11.3 ± 4.6 mIU/mL in group A (P<.05).

Conclusion(s)

Pretreatment with OCPs in GnRH agonist flare protocol suppresses pre-Lupron FSH but does not blunt FSH flare. It blunts LH flare, which may be beneficial.

Key Words: Oral contraceptive pills, flare protocol, poor responders