Tuesday, December 16, 2014

Taking birth control pills before an IVF cycle reduces pregnancy rates

Many IVF clinics routinely put their patients on birth control pills ( oral contraceptives)  prior to starting an IVF cycle.

This sounds very counter-intuitive  -  after all, why would you want to suppress the fertility of an infertile patient even further by using anti-fertility medications ? Many patients are understandably puzzled about why they need birth control pills, and are worried about their  side-effects.

The reason that doctors have used birth control pills prior to starting IVF is 3-fold.

1. They believe that by suppressing the follicles prior to starting superovulation, the follicles which grow during IVF will be a synchronous cohort. The hope is that by putting on the brakes prior to gunning the accelerator, all the follicles will be at the same point when the superovulation starts, so that hopefully they will all grow at the same rate. They believe that this will also reduce the chances of cyst formation.

2. They believe that this will improve ovarian response to the superovulation. The logic is that
"  resting " the ovaries before starting Gonal- F/ Follistim/ FSH/HMG will help the ovaries to respond better.

3. They use this in order to "program" the cycles. This is very useful, especially for clinics who need to batch their patients together. By regulating the cycles of lots of patients by putting them on birth control pills, and stopping this on a fixed date, they can cycle large batches of patients together for IVF, thus increasing the clinic's throughput and efficiency.

However, a recent study ( Does hormonal contraception prior to in vitro fertilization (IVF) negatively affect oocyte yields? http://www.rbej.com/content/11/1/28#B11)  has shown that the use of birth control pills prior to IVF cycles actually reduces the number of eggs collected in donor egg IVF cycle.

The deleterious effects of birth control pills for women with poor ovarian reserve who are doing IVF is likely to be even more !

It's high time IVF clinics stopped applying IVF superovulation protocols mindlessly,  especially for women with low AMH levels. These women need individualised superovulation, to maximise their chances of a pregnancy.

Need help in making sure your IVF superovulation protocol is optimal ? Please send me your medical details by filling in the form at http://www.drmalpani.com/second-opinion so that I can guide you better !

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