Comparison of FSH flare with and without pretreatment with oral contraceptive pills in poor responders undergoing in vitro fertilization

Objective: To compare FSH, LH, estrogen, and P flare response following 1 mg lupron injection in poor responders with or without pretreatment with oral contraceptive pills (OCPs). Design: Prospective study. Setting: University hospital. Patient(s): Poor responders undergoing IVF flare protocol from October 2002 to November 2003. Intervention(s): Patients were divided into group A, who received OCPs before IVF cycle (n = 12), and group B, who did not (n = 7). One milligram Lupron was injected SC after measuring day 2 serum FSH, LH, estrogen, and P. After 24 hours, serum hormones were measured before lupron administration. Main outcome measure(s): Serum FSH, LH, estrogen, and P before and after 1 mg lupron. Result(s): Basal FSH was similar in both groups (8.6 ± 4.5 vs. 9.6 ± 2.9 mIU/mL). Group A patients had significantly lower day 2 FSH (3.6 ± 3.6 vs. 10.1 ± 4.2 mIU/mL; P<.05). After lupron, although both groups had a significant rise in FSH and LH, mean LH rise in group B was 39.5 ± 31 mIU/mL versus 11.3 ± 4.6 mIU/mL in group A (P<.05). Conclusion(s): Pretreatment with OCPs in GnRH agonist flare protocol suppresses pre-Lupron FSH but does not blunt FSH flare. It blunts LH flare, which may be beneficial.