Profound Pituitary Suppression Following Oral Contraceptive Pretreatment in Gonadotropin-releasing Hormone Antagonist Cycles Does Not Impact Outcome: A Retrospective Cohort Study

Background: This retrospective study evaluated the effect of profound pituitary suppression with oral contraceptive pill (OCP) pretreatment in gonadotropin-releasing hormone (GnRH) antagonist cycles stimulated with recombinant follicle stimulating hormone plus highly purified human menopausal gonadotropin. Methods: The analysis included women aged 20-46 years (N=318) who utilized OCP pretreatment in a private academic in vitro fertilization center between January 2008 and January 2010. Patients were retrospectively divided based on endogenous luteinizing hormone (LH) level (≤1.5 [n=75] vs. >1.5 [n=243] mIU/mL) on stimulation day 1. Results: In the LH ≤1.5 and >1.5 mIU/mL groups, respectively, the mean number of stimulation days was 10.9 and 9.5 days (P<0.0001); mean total gonadotropin use was 4,328 and 3,543 IU (P<0.0001). Oocyte retrieval was greater in the LH ≤1.5 versus >1.5 mIU/mL group (17.7 vs. 14.9 oocytes; P=0.02). Pregnancy outcomes were similar between groups. Longer OCP duration correlated with lower day 1 LH levels (r=–0.161, P=0.007). Greater LH suppression correlated with increased total gonadotropin dose (r=–0.227, P<0.001) and days of stimulation (r=–0.445, P<0.001). Conclusion: Women with profound LH suppression following OCP pretreatment demonstrated comparable prognosis compared with women without profound LH suppression, despite requiring longer stimulations and a higher total gonadotropin dose.