Question 60. My reproductive endocrinologist has recommended a protocol that uses birth control pills. Why would birth control pills be used in IVF?

Last night I was speaking to a group of high school students that are interested in medicine as a career. I have spoken to such groups many times over the past 5 years and sometimes I feel like I am on the TV show "Kids Say the Darndest Things." Sometimes they get hung up on asking about transgendered individuals. Sometimes they ask about multiples like John and Kate plus Eight or the Octomom. Last night we got sidetracked into a discussion of the NuvaRing and oral contraceptives. These are high school kids I remind you....When I was in high school I spent most Saturday nights watching the Love Boat....I certainly was not wondering which girls were on forms of oral contraception. But amazingly enough I was able to eventually date, marry and reproduce...it gives me hope that geeks everywhere will be able to overcome social adversity...just look at Leonard on the Big Bang Theory as another success story!

Ok. So it's Friday afternoon and I am off this weekend so I am a bit punchy....What does all this have to do with IVF? Well some IVF protocols actually use oral contraceptives as part of the medication recipe. Personally, we don't use a lot of OCPs except in high responders. Recently I had a patient that came in for a second opinion prior to stimulated IVF. Her planned protocol was OCPs plus luteal Lupron and then stimulation drugs. She was 38 years old with an AMH of 0.5 and I recommended against that approach because I thought she would be over suppressed. Ultimately she went back to the original clinic, followed that recipe and never came close to egg collection as her stimulation was a total bust. She called me up and we discussed the plan over the phone and she was very upset....why did that clinic use OCPs on everyone? I told her that I couldn't answer that question and she should ask her RE at that clinic. She said that she was calling me since they never return her calls! Oh well. Hopefully next time she will have a better response...

So here is today's Question of the Day from 100 Questions and Answers about Infertility, Second Edition...

60. 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). 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 on OCPs, we add Lupron. After 1 more week, we stop the OCPs and continue the Lupron and wait for withdrawal bleeding. Once a patient has bled, we begin the gonadotropin stimulation.

Some clinics use OCPs as part of the protocol for microdose Lupron (MDL) flare, traditional flare, or GnRH-antagonist (Antagon, Centrotide) cycles 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 used 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.