To the Editor:
I read with interest the recently published Reflections paper by Bosch (1) on the ongoing debate entitled: “Can we skip weekends in GnRH antagonist cycles without compromising the final outcome?” This article comprehensively covered the role of oral contraceptive (OC) pretreatment in patients undergoing the GnRH-antagonist controlled ovarian hyperstimulation (COH) protocol for in vitro fertilization–embryo transfer (IVF-ET) cycle.
To summarize, while OC pretreatment results in “dual benefit”–a better synchronized response and a scheduled cycle–it was associated with a significantly lower ongoing pregnancy rate, longer duration of the stimulation, and higher gonadotropin consumption. The detrimental effect of OC pretreatment was related to the potential negative effect of the gestagen component on the endometrium, or the low endogenous LH levels induced by OCs with their deleterious impact on oocyte competence or endometrial receptivity. Regarding the latter, Bosch suggested the addition of LH or the use of hMG during COH, in order to overcome the negative influence of low LH. Read the rest of this entry »