Birth Control Pills and IVF Protocols

Many of the questions that I answer on the INCIID (www.INCIID.org) bulletin board revolve around medication protocols especially the use of oral contraceptives. Personally, I have had poor results with the use of oral contraceptives except in known high responding patients. I know that many clinics use pills in protocols without any problems but my own experience has not been very positive.

So here is today’s “Question of the Day” from the book that really needs some more reviews on Amazon.com…100 Questions and Answers About Infertility. As the snow starts to fall here in Washington paralyzing the government, I want to invite all local readers of this blog (and their friends and family) to the Barnes and Noble Bookstore in Clarendon, VA for a book signing of this book on Saturday January 26th from Noon until 2 PM.



64. My reproductive endocrinologist has recommended a protocol that uses birth control pills. Why would birth control pills be used in IVF?
Birth control pills or, more correctly, oral contraceptive pills (OCPs) can be used as a part of the IVF stimulation protocol in several different settings. First, in patients who are known or suspected to be high responders, OCPs may help mitigate the risk of ovarian hyperstimulation syndrome (OHSS; see Question 67).

Second, in patients without predictable regular menstrual cycles, OCPs can be used in combination with Lupron to initiate an IVF cycle. In our practice, we usually start OCPs in such cases after confirming with a blood test that the woman has not recently ovulated. Then, after 1 week, we add Lupron. After 1 more week, we stop the Lupron and wait for withdrawal bleeding. Once a patient has bled, we begin the gonadotropin stimulation.

Third, some clinics use OCPs for microdose Lupron (MDL) flare, traditional flare, or patients who are taking Antagon in the hope that pretreatment with OCPs will prevent one follicle from growing faster than the other follicles once the stimulation has begun. We have not routinely use OCPs with our MDL flare patients, as we have rarely had problems with the emergence of a single dominant follicle compared with the more common problem of oversuppression and a cancelled cycle. Given that prolonged OCP use can lead to oversuppression in low responders, we use these medications very carefully.