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Estrogen helps schedule IVF sessions with GnRH antagonists

NEW YORK (Reuters Health) – Estrogen pretreatment appears to be a safe alternative to oral contraceptives for programming GnRH antagonist cycles in good-prognosis patients during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), according to French researchers.

Estrogen pretreatment “is well accepted by patients and helps them to schedule in advance ovarian stimulation monitoring,” Dr. Isabelle Cedrin-Durnerin told Reuters Health by email. “For the assisted reproduction team, it helps to distribute work load with the same flexibility as the long GnRH agonist protocol.”

Dr. Cedrin-Durnerin of Hopital Jean Verdier, Bondy and colleagues note that the GnRH antagonist protocol offers advantages over the long agonist protocol but it lacks cycle programming. Oral contraceptives in concert with the GnRH antagonist protocol have been shown to be effective in avoiding ovarian retrievals during weekends, but this approach might have a negative effect on pregnancies, they said in the paper.

Another possibility is estrogen pretreatment, and the researchers investigated the impact of 17beta-estradiol or no pretreatment in 472 patients undergoing IVF/ICSI. The treatment was given before daily recombinant FSH administration started on the first day of estrogen discontinuation (or on cycle day 2 in nonpretreated women).

There was no significant between-group difference in the number of oocytes retrieved or in embryos obtained. Although the estrogen group received significantly more FSH (1557 vs 1389 IU) and had a longer simulation duration (10.8 vs 10.0 days), the differences were slight.

The two groups also had similar rates of positive pregnancy tests (36.0% vs 38.2%), ultrasound pregnancy (33.0% vs 35.4%) and deliveries per cycle (26.6% vs 30.0%).

The study did not confirm the potential benefits of this approach, say the investigators, “but showed that this pretreatment, which is convenient for scheduling IVF, does not negatively affect cycle outcome.”

“In the absence of any deleterious effect on cycle outcome, they conclude, “estrogen pretreatment should be used in clinical practice for programming antagonist cycles to favor oocyte retrievals during working days.”

SOURCE: http://bit.ly/K76X7w

Fertil Steril 2012.