Influence of pituitary suppression with triphasic or monophasic oral contraceptives on the outcome of in vitro fertilization and embryo transfer

  • Ming-Ting Chung
  • Yung-Chieh TsaiEmail author
  • Sheng-Hsien Chen
  • Tao-Chuan Loo
  • Hsun-Han Tang
  • Liang-Yin Lin
Assisted Reproduction


Purpose: To compare the clinical outcome of IVF treatment after pituitary suppression with two different oral contraceptives (OCs).

Methods: 65 patients who received IVF treatment was classified into 2 groups based on the difference of OCs they used for pituitary suppression before ovarian hyperstimulation. Group 1 included 36 patients who received monophasic OCs. Group 2 included 29 patients who received triphastic OCs. Both groups received the OCs from the 5th day of the cycle for consecutive 21 days. The hormone profiles after OCs and clinical outcome of IVF treatment were compared between two groups. Two-sample t-tests and X2 tests were used for statistical analyses. P < 0.05 was considered statistically significant.

Results: The mean age and basal hormone profiles were comparable between two groups. After ovulation suppression with different OCs, the day 2 FSH and LH value revealed statistically significant difference between two groups(4.2±1.8 vs 6.0±2.6; 2.7±2.0 vs 4.2±3.3 respectively). The numbers of oocyte per retrieval and fertilization rate were comparable between two groups, but higher quality embryos as revealed by the cleavage speed were noted in the triphastic OCs group. Although statistically not significant, higher implantation rate and pregnancy rate were also noted in the triphastic OCs group.

Conclusions: Different OCs for pituitary suppression can result in different hormone profiles. Ovulation induction in IVF treatment should be individualized according to these hormone changes to achieve the optimal clinical outcome. Triphastic OCs exceeds monophastic OCs in producing good quality embryo in IVF-ET treatment.


Early cleavage embryo In vitro fertilization Oral contraceptives Ovulation induction 


  1. 1.
    Damario MA, Barmat L, Liu HC, Davis OK, Rosenwaks Z. Dual suppression with oral contraceptives and gonadotrophin releasing- hormone agonists improves in-vitro fertilization outcome in high responder patients. Hum Reprod 1997;12:2359–65.PubMedCrossRefGoogle Scholar
  2. 2.
    Suikkari AM, Tiitinen A, Stenman UH, Seppala M, Laatikainen T. Oral contraceptives increase insulin-like growth factor binding protein-1 concentration in women with polycystic ovarian disease. Fertil Steril 1991;55:895–9.PubMedGoogle Scholar
  3. 3.
    Benadiva CA, Ben-Rafael A, Blasco L, et al. Ovarian response to human menopausal gonadotropin following suppression with oral contraceptives. Fertil Steril 1988;50:516–8.PubMedGoogle Scholar
  4. 4.
    Clifford K, Rai R, Watson H, et al. Does suppressing luteinising hormone secretion reduce the miscarriage rate? Results of a randomized controlled trial. Br Med J 1996;312:1508–11.Google Scholar
  5. 5.
    Biljan MM, Mahutte NG, Dean N, Hemmings R, Bissonnette F, Tan SL. Pretreatment with an oral contraceptive is effective in reducing the incidence of functional ovarian cyst formation during pituitary suppression by gonadotropin-releasing hormone analogues. J Assist Reprod Genet 1998;15:599–604.PubMedCrossRefGoogle Scholar
  6. 6.
    Barmat LI, Chantilis SJ, Hurst BS, Dickey RP. A randomized prospective trial comparing gonadotropin-releasing hormone (GnRH) antagonist/recombinant follicle-stimulating hormone (rFSH) versus GnRH-agonist/rFSH in women pretreated with oral contraceptives before in vitro fertilization. Fertil Steril 2005;83:321–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Mashiach S, Dor J, Goldenberg M, Shalev J, Blankstein J, Rudak E, Shoam Z, Finelt Z, Nebel L, Goldman B. Protocols for induction of ovulation. The concept of programmed cycles. Ann N Y Acad Sci 1988;541:37–45.PubMedGoogle Scholar
  8. 8.
    Cedars MI. Triphasic oral contraceptives: review and comparison of various regimens. Fertil Steril 2002;77:1–14.PubMedCrossRefGoogle Scholar
  9. 9.
    Rabe T, Nitsche DC, Runnebaum B. The effects of monophasic and triphasic oral contraceptives on ovarian function and endometrial thickness. Eur J Contracept Reprod Health Care 1997;2:39–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Filicori M. The role of luteinizing hormone in folliculogenesis and ovulation induction. Fertil Steril 1999;71:405–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Couzinet B, Lestrat N, Brailly S, Forest M, Schaison G. Stimulation of ovarian follicular maturation with pure follicle-stimulating hormone in women with gonadotropin deficiency. J Clin Endocrinol Metab 1988;66:552–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Daya S, Gunby J, Hughes EG, Collins JA, Sagle MA. Follicle-stimulating hormone versus human menopausal gonadotropin for in vitro fertilization cycles: a meta-analysis. Fertil Steril 1995;64:347–54.PubMedGoogle Scholar
  13. 13.
    van Wely M, Westergaard LG, Bossuyt PM M, van Der Veen F. Effectiveness of human menopausal gonadotropin versus recombinant follicle-stimulating hormone for controlled ovarian hyperstimulation in assisted reproductive cycles: a meta-analysis. Fertil Steril 2003;80:1086–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Westergaard LG, Erb K, Laursen SB, Rex S, Rasmussen PE. Human menopausal gonadotropin versus recombinant follicle-stimulating hormone in normogonadotropic women down-regulated with a gonadotropin-releasing hormone agonist who were undergoing in vitro fertilization and intracytoplasmic sperm injection: a prospective randomized study. Fertil Steril 2001;76:543–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Tsai YC, Chung MT, Sung YH, Tsai TF, Tsai YT, Lin LY. Clinical value of early cleavage embryo. Int J Gynecol Obstet 76:293–97.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Ming-Ting Chung
    • 1
  • Yung-Chieh Tsai
    • 1
    Email author
  • Sheng-Hsien Chen
    • 1
  • Tao-Chuan Loo
    • 1
  • Hsun-Han Tang
    • 1
  • Liang-Yin Lin
    • 1
  1. 1.Center for Reproductive Medicine, Department of Obstetrics and GynecologyChimei Medical CenterTainanTaiwan

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