Optimal Candidates to Do Fresh Embryo Transfer in Those Using Oral Contraceptive Pretreatment in IVF Cycles

Yao Lu; Yichao Niu; Yuan Wang; Yaqiong He; Ying Ding; Xinyuan Lu; Bing Xu; Steven R Lindheim; Yun Sun

doi:10.3389/fphys.2021.576917

Optimal Candidates to Do Fresh Embryo Transfer in Those Using Oral Contraceptive Pretreatment in IVF Cycles

Front Physiol. 2021 Mar 11:12:576917. doi: 10.3389/fphys.2021.576917. eCollection 2021.

Authors

Yao Lu^{1

2}, Yichao Niu^{1

2}, Yuan Wang^{1

2}, Yaqiong He^{1

2}, Ying Ding^{1

2}, Xinyuan Lu³, Bing Xu^{1

2}, Steven R Lindheim⁴, Yun Sun^{1

2}

Affiliations

¹ Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
² Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.
³ Key Laboratory of Health Technology Assessment of Ministry of Heath, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China.
⁴ Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States.

Abstract

Objective: Concern regarding the adverse impact of pretreatment of oral contraceptives (OC) prior to ovarian stimulation for in vitro fertilization (IVF) on pregnancy outcome has been debated. We investigated factors that may be associated with live birth rate (LBR) in fresh embryo transfer cycles after OC pretreatment.

Methods: A retrospective study was conducted at the Reproductive Center of Ren Ji Hospital, Shanghai, China. 814 women aged 20-35 years undergoing their first autologous IVF cycle and fresh embryo transfer after OC pretreatment were included. Long gonadotropin releasing hormone (GnRH) agonist (a) or GnRH antagonist (ant) protocol was used for ovarian stimulation. Predictive factors for LBR were identified using multivariate logistic regression analysis.

Results: Multivariate logistic regression analysis demonstrated that using GnRH-ant protocol for ovarian stimulation was associated with significantly lower LBR (OR 0.70, 95% CI 0.52-0.93), while endometrial thickness on day of hCG trigger was associated with increased LBR (OR 1.16, 95% CI 1.06-1.27). Despite comparable patients' age, duration of infertility, BMI and basal FSH between GnRH-a and GnRH-ant groups, those using GnRH-ant resulted in significantly lower LBR compared to the GnRH-a group (37.4 vs. 48.5%, p = 0.002). Using ROC analysis and a cut-off endometrial thickness of < and ≥ 9.5 mm, those < 9.5 mm using GnRH-ant resulted in significantly lower LBR (28.5 vs. 43.4%, p = 0.004), while no differences were noted with an endometrial thickness ≥9.5 mm (49.6 vs. 51.1%, p = 0.78).

Conclusions: Live birth was significantly impacted in OC pre-treated GnRH-ant cycles with an endometrial thickness of <9.5 mm on day of hCG trigger. Cryopreservation of all embryos in these cycles should be considered.

Keywords: GnRH agonist; GnRH antagonist; fresh embryo transfer; in vitro fertilization; oral contraceptive.