The ultrashort flare GnRH-agonist/GnRH-antagonist protocol enables cycle programming and may overcome the “detrimental effect” of the oral contraceptive

29 06 2012

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 »

Discussion on letrozole-Gn-antagonist group needing an early start of antagonist

4 05 2011

To the Editor:

I read with great interest the article by Elassar et al. (1) in which they addressed the risk of a premature luteinizing hormone (LH) surge (LH ≥ 10 mIU/mL occurring before the detection of the leading follicle ≥ 18 mm in diameter) in letrozole-gonadotropin (Gn)-antagonist group and suggested that “an early start and possibly a higher dose of the antagonist should be considered when using letrozole.” This is a good concept. But they did not explore the cause. They mentioned “ovaries with diminished ovarian reserve are more prone to a premature LH surge.” However, it is not the cause leading to the high rate of premature LH surge associated with letrozole supplementation. Read the rest of this entry »

Androgen pre-treatment in poor responders undergoing controlled ovarian stimulation and IVF treatment

25 04 2011

To the Editor:

We updated our meta-analysis (1) following the recent publication of a randomized controlled trial (RCT) evaluating the effect of testosterone pre-treatment in poor responders undergoing IVF treatment (2).

Our updated meta-analysis of RCTs of adjuvant androgens [DHEA (dehydroepiandrosterone) and testosterone] in poor responders showed a significant improvement in the ongoing pregnancy/ live birth rates (RR 2.08; 95% CI: 1.10, 3.93; p = 0.002, Figure 1). Meta-analysis for the outcome of total dose of gonadotrophin consumption showed a significantly lower gonadotrophin consumption in the androgen supplementation group compared to the control group (WMD -464.66; 95% CI: – 612.90 to -312.42; p < 0.01, Figure 2). Read the rest of this entry »