使用pill會抑制LH

COH前使用pill會抑制COH過程之LH，可能下降IVF懷孕率

http://humrep.oxfordjournals.org/content/21/2/352.full

Effect of oral contraceptive pill pretreatment on ongoing pregnancy rates in patients stimulated with GnRH antagonists and recombinant FSH for IVF. A randomized controlled trial

BACKGROUND: The objective of this randomized controlled trial was to assess the effect of oral contraceptive pill (OCP) pretreatment on the probability of ongoing pregnancy in patients treated with a GnRH antagonist for IVF. METHODS: A fixed dose of 200 IU recombinant FSH (rFSH) was started in 425 patients either on day 2 of the menstrual cycle (non-OCP group: n = 211) or 5 days after discontinuing the OCP (OCP group: n = 214). GnRH-antagonist was initiated on day 6 of stimulation, and triggering of final oocyte maturation was performed with 10,000 IU of HCG. RESULTS: Ongoing pregnancy rates per started cycle in the non-OCP and OCP group were 27.5% and 22.9%, respectively [95% confidence interval (CI) of the difference: −3.7 to +12.8]. Pregnancy loss was significantly increased in the OCP (36.4%) compared with the non-OCP group (21.6%) (95% CI of the difference: −28.4 to −2.3). CONCLUSION: Pretreatment with OCP, as compared with initiation of stimulation on day 2 of the cycle in patients treated with GnRH antagonist and recombinant FSH, appears to be associated with a not significant difference in ongoing pregnancy rates per started cycle and results in a significantly higher early pregnancy loss.

Table II.

Hormonal values in the non- oral contraceptive pill (non-OCP) group and OCP group

	Non-OCP group	OCP group
	At initiation of stimulation	At initiation of stimulation 5 days after OCP discontinuation	P	At OCP initiation
FSH	7.5 ± 2.4	7.7 ± 3.20	ns	7.5 ± 2.4b
LH	5.2 ± 2.2	4.8 ± 2.7a	<0.01	5.2 ± 2.2b
E2	39.1 ± 13.7	31.2 ± 17.4a	<0.01	41.1 ± 20.5b
Progesterone	0.7 ± 0.3	0.5 ± 0.3a	<0.01	0.7 ± 0.3b

	Day 6 of stimulation
FSH	15.2 ± 4.4	16.0 ± 4.3	ns
LH	2.7 ± 3.6	1.9 ± 1.9	<0.01
E2	723 ± 472	676 ± 465	ns
Progesterone	0.7 ± 0.4	0.6 ± 0.3	ns

	Day of HCG
FSH	14.8 ± 4.4	14.6 ± 4.4	ns
LH	2.1 ± 1.9	1.3 ± 1.9	<0.001
E2	2071 ± 1038	1901 ± 1038	ns
Progesterone	1.3 ± 0.9	1.4 ± 0.9	ns

• ↵a Significant difference compared to the values present at OCP initiation, and compared to the values present at initiation of stimulation in the non-OCP group.
• ↵b Difference not significant compared with non-OCP group prior to treatment. ns = non significant.

Table IV.

Pregnancy outcome in the non-oral contraceptive pill (OCP) and OCP group

	Non-OCP group	OCP group
Patients who started stimulation	211	214
Patients who reached oocyte retrieval	203	209
Patients who reached embryo transfer	187	191

			Difference (95% confidence interval)
Positive HCG per started cycle	35.1% (74/211)	36.0% (77/214)	0.9% (−9.9 to +8.1)
Ongoing pregnancy rate per started cycle	27.5%(58/211)	22.9%(49/214)	4.6% (−3.7 to +12.8)
Ongoing pregnancy rate per patient randomized*	20.4%(60/254)	23.6%(51/250)	3.2% (−4.0 to +10.4)
Ongoing pregnancy rate per oocyte retrieval	28.6% (58/203)	23.4% (49/209)	5.1% (−3.3 to +13.5)
Ongoing pregnancy rate per embryo transfer	31.0% (58/187)	25.7% (49/191)	5.4% (−3.7 to +14.3)
Ongoing implantation rate (%)	24.4 ± 39.0	18.2 ± 33.6	6.2% (−1.2 to +13.5)
Early pregnancy loss	21.6% (16/74)	36.4% (28/77)	–14.7% (−28.4 to −2.3)

• All differences between the two groups are not significant with the exception of the comparison of early pregnancy loss in which P < 0.05. *Including the spontaneously occurred pregnancies in patients randomized in the two groups.
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