Estrogen pretreatment prior to controlled ovarian stimulation. Does It improve IVF outcomes in poor responders as compared to oral contraceptive pill or no pretreatment? Our experience
Sara Pinelli (IT), Giovanna Simi (IT), Maria Elena Obino (IT), Francesca Papini (IT), Maria Ruggiero (IT), Elena Casarosa (IT), Stefano Basile (IT), Vito Cela (IT), Paolo Artini (IT)
[Pinelli] University of Pisa, [Simi] University of Pisa, [Obino] University of Pisa, [Papini] University of Pisa, [Ruggiero] University of Pisa, [Casarosa] University of Pisa, [Basile] University of Pisa, [Cela] University of Pisa, [Artini] University of Pisa
Context – Poor responders are a challenging group of patients in assisted reproductive technologies. Estrogens exert a negative feedback on hypothalamic-pituitary axis and may reduce level of circulating FSH. Objective – To verify whether estrogen pretreatment for 3 months before a cycle of ovarian stimulation for in vitro fertilization (IVF) could enhance follicular response and therefore improve outcomes in poor responders compared with either pretreatment with oral contraceptive pill (OCP) or no pretreatment. Methods –Prospectical pilot study involving 50 women referred to our outpatient center of infertility at Pisa University. Patient(s) –Patients were defined poor responders according to ESHRE criteria. They underwent IVF with either OCP or estrogen pretreatment or no pretreatment before a standard GnRH antagonist short protocol. Intervention(s) – we evaluated clinical and laboratory data of patients undergoing IVF cycles in our 3 groups. Main Outcome Measure(s) – Main outcome measures were ongoing pregnancy rates, number and quality of oocytes retrieved and cancellation rate. Result(s) – Our 3 groups were similar in baseline characteristics. We found no significant differences in gonadotropin requirement, cancellation rate, and number of embryos transferred. Ongoing pregnancy rates were higher in the estrogen pretreatment group compared both with OCP group and with no pretreatment group. Trends toward higher number of oocytes retrieved and better oocyte quality were also observed in estrogen pretreatment group. Conclusions - Estrogen pretreatment seems to improve IVF outcomes in standard GnRH short protocol when compared to OCP or no pretreatment in poor responders. Randomized trials with larger cohort of patients are needed to clarify the optimal method of pretreatment in ovarian controlled stimulation in poor responders.