AUGMENTATION OF LOW OVARIAN RESPONSE TO SUPEROVULATION BEFORE IN-VITRO FERTILIZATION FOLLOWING PRIMING WITH CONTRACEPTIVE PILLS

Poor ovarian response to superovulation treatment is observed in a cer tain group of patients, the so-called 'low responders', Despite the ev olution of sophisticated controlled ovarian hyperstimulation (COH) reg imens prior to the in vitro fertilization (IVF), the ideal stimulation protocol for the low responder has yet to be formulated. The objectiv e of this study was to assess the effect of oral contraceptive pills ( OCP), administered before the initiation of superovulation, on ovarian response and IVF treatment results in patients with previous 'low res ponse' to exogenous gonadotropin stimulation, The study group comprise d 42 patients who had exhibited poor ovarian response to standard supe rovulation protocols in at least two previous consecutive treatment at tempts, Contraceptive pills were administered for 28-42 days and were immediately followed by menotropin treatment, The study group (n=50 cy cles) was compared with the control group consisting of previous cycle s (n=88) of the same women, Significant differences were noted in peak estradiol levels (983+/-739 vs. 517+/-249 pg/ml; P <0.01, paired Stud ent's t test) and number of pre-ovulatory follicles between the study and the control groups. Thirty-three of the cycles (66%) reached the s tage of ovum pick-up, compared with 22 (25%) of the previous IVF cycle s in these women. The mean number of oocytes retrieved was 6.1+/-3.0 a nd 2.4+/-1.3 in the study and control groups, respectively (P <0.01; p aired Student's t test). Embryo transfer (ET) was performed in 62% of the treatment cycles and resulted in five clinical pregnancies (16.1% per ET). No pregnancies were recorded in the control group. This study demonstrates the beneficial effect of OCP given prior to IVF treatmen t, and provides an efficient treatment modality for women who consiste ntly respond poorly to standard COH protocols.