Journal of Assisted Reproduction and Genetics

, Volume 15, Issue 10, pp 599–604 | Cite as

Pretreatment with an Oral Contraceptive Is Effective in Reducing the Incidence of Functional Ovarian Cyst Formation During Pituitary Suppression by Gonadotropin-Releasing Hormone Analogues

  • Marinko M. Biljan
  • Neal G. Mahutte
  • Nicola Dean
  • Robert Hemmings
  • Francois Bissonnette
  • Seang Lin Tan


Purpose: Our purpose was to assess the effect of pretreatment with oral contraceptives (OCs) on the formation of functional ovarian cysts during pituitary supression with gonadotropin-releasing hormone (GnRH) agonists, subsequent follicular development, and pregnancy rates.

Methods:A retrospective case-controlled study of 31 in vitro fertilization (IVF) patients, all of whom in a previous cycle had commenced the long protocol of GnRH-agonist (Buserelin) in the early follicular phase and were pretreated in a subsequent cycle with 2 weeks of an OC containing 30 μg of ethinyl estradiol and 150 μg of desogestrel prior to GnRH-agonist administration, was undertaken. Follow-up visits were arranged after a minimum of 11 days of GnRH-agonist administration and weekly thereafter until pituitary suppresion was achieved.

Results: Cysts were detected in 16 (51.6%) of the 31 patients not pretreated with OCs, and in 0 (0%) of the 31 patients pretreated with OCs (odds ratio = 67.1; 95% confidence interval = 5.6–350.7). Patients pretreated with OCs achieved pituitary suppression more rapidly (median difference = 4 days; 95% confidence interval = 2–7) and had comparable gonadotropin requirements and pregnancy rates.

Conclusions: Pretreatment with OCs prior to pituitary suppression in the early follicular phase decreases ovarian cyst formation, without an apparent effect on subsequent follicular recruitment or pregnancy rates.

oral contraceptive long protocol pituitary suppression gonadotropin releasing-hormone agonist 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Tan SL, Maconochie N, Doyle P, Campbell S, Balen A, Bekir J, Brinsden P, Edwards RG, Jacobs HS: Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin. Am J Obstet Gynecol 1994;171:513–520Google Scholar
  2. 2.
    Tan SL, Balen A, el Hussein E, Mills C, Campbell S, Yovich J, Jacobs, HS: A prospective randomized study of the optimum timing of human chorionic gonadotropin administration after pituitary desensitization in in vitro fertilization. Fertil Steril 1992;57:1259–1264Google Scholar
  3. 3.
    Meldrum DR, Gutlay AL, Wisot A, Huynh D, Hamilton F, Kempton W: Timing of initiation and dose schedule of leuprolide influence the time course of ovarian suppresson. Fertil Steril 1988;50:400–402Google Scholar
  4. 4.
    Forman RG, Demouzon J, Feinstein MC, Testart J, Frydman R: Studies on the influence of gonadotrophin levels in the early follicular phase on the ovarian response to stimulation. Hum Reprod 1991;6:113–117Google Scholar
  5. 5.
    Shaker AG, Pittrof R, Zaidi J, Bekir J, Kyei-Mensah A, Tan SL: Administration of progestogens to hasten pituitary desensitization after the use of gonadotropin-releasing hormone agonist in in vitro fertilization—A prospective randomized study. Fertil Steril 1995;64:791–795Google Scholar
  6. 6.
    Adams J, Franks S, Polson DW, et al.: Multifollicular ovaries: clinical and endocrine features and response to pulsatile gonadotropin releasing hormone. Lancet 1985;2:1375–1379Google Scholar
  7. 7.
    Steer CV, Mills CL, Tan SL, Campbell S, Edwards RG: The cumulative embryo score: A predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer programme. Hum Reprod 1992;7:117–119Google Scholar
  8. 8.
    Tan SL, Doyle P, Campbell S, Beral V, Rizk B, Brinsden P, Mason B, Edwards RG: Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies. Am J Obstet Gynecol 1992;167:778–784Google Scholar
  9. 9.
    Tan SL, Kingsland C, Campbell S, Mills C, Bradfield J, Alexander N, Yovich J, Jacobs HS: The long protocol of administration of gonadotropin-releasing hormone agonist is superior to the short protocol for ovarian stimulation for in vitro fertilization. Fertil Steril 1992;57:810–814Google Scholar
  10. 10.
    Ron-El R, Herman A, Golan A, van der Ven H, Caspi E, Diedrich K: The comparison of early follicular and midlateal administration of long-acting gonadotropin-releasing hormone agonist. Fertil Steril 1990;54:233–237Google Scholar
  11. 11.
    Rizk B, Tan SL, Kingsland C, Steer C, Mason BA, Campbell S: Ovarian cyst aspiration and the outcome of in vitro fertilization. Fertil Steril 1990;54:661–664Google Scholar
  12. 12.
    Aston K, Arthur I, Masson GM, Jenkins JM: Progestogen therapy and prevention of functional ovarian cysts during pituitary desensitisation with GnRH agonists. Br J Obst Gynaecol 1995;102:835–837Google Scholar
  13. 13.
    Ron-El R, Herman A, Golan A, Raziel A, Soffer Y, Caspi E: Follicle cyst formation following long-acting gonadotropin-releasing hormone analog administration. Fertil Steril 1989;52:1063–1066Google Scholar
  14. 14.
    McNatty KP: Hormonal correlates of follicular development in the human ovary. Aust J Bio Sci 1981;34:249–268Google Scholar
  15. 15.
    Tsai CC, Yen SSC: The effect of ethinyl estradiol administration during early follicular phase of the cycle on the gonadotropin levels and ovarian function. J Clin Endocrinol Metab 1971;33:917–923Google Scholar
  16. 16.
    Templeton A, Van Look P, Lumsden MA, Angell R, Aitken J, Dunkan AW, Baird DT: The recovery of pre-ovulatory oocytes using a fixed schedule of ovulation induction and follicle aspiration. Br J Obstet Gynaecol 1984;91:148–154Google Scholar
  17. 17.
    Cedrin-Durnerin I, Bulwa S, Herve F, Martin-Pont B, Uzan M, Hugues J: The hormonal flare-up following gonadotrophin-releasing hormone agonist administration is influenced by a progestogen pretreatment. Hum Reprod 1996;11:1859–1862Google Scholar
  18. 18.
    Strohmer H, Chatwani S, Weiser F, Danninger B, Obruca A, Feichtinger W: Prospective randomized study of an ultrashort gonadotrophin-releasing hormone agonist versus a modified suppression protocol for ovarian stimulation in intracytoplasmatic sperm injection cycles. Hum Reprod 1997;12:1403–1408Google Scholar
  19. 19.
    Benadiva CA, Ben-Rafael Z, Blasco L, Tureck R, Mastroianni L, Flickinger GL: Ovarian response to human menopausal gonadotropin following suppression with oral contraceptives. Fertil Steril 1988;50:516–518Google Scholar
  20. 20.
    Gonen Y, Jacobson W, Casper RF: Gonadotropin suppression with oral contraceptives before in vitro fertilization. Fertil Steril 1990;53:282–287Google Scholar
  21. 21.
    Cohen J, Debache C, Solal P, Serkine AM, Achard B, Boujenah A, Pez JP, Paris X, Robert J, Loffredo V: Results of planned in-vitro fertilization programming through the pre-administration of the oestrogen-progesterone combined pill. Hum Reprod 1987;2:7–9Google Scholar
  22. 22.
    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;12:2359–2366.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Marinko M. Biljan
    • 1
  • Neal G. Mahutte
    • 1
  • Nicola Dean
    • 1
  • Robert Hemmings
    • 1
  • Francois Bissonnette
    • 1
  • Seang Lin Tan
    • 1
  1. 1.McGill Reproductive Center, Department of Obstetrics and GynecologyRoyal Victoria Hospital, Women's PavilionMontrealCanada

Personalised recommendations