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How Birth Control May Impact the Outcome of Your IVF Cycle
May 6, 2013
In many traditional in vitro fertilization (IVF) protocols, the fertility patient is instructed to take oral contraceptive birth control pills to suppress natural hormones. This creates a “blank slate” for ovarian stimulation to take place and allows fertility doctors to have the most control over the course of an IVF cycle. However, new findings suggest that taking birth control as part of an IVF cycle may actually reduce the quantity and quality of eggs retrieved.
David Barad, M.D. of the Center for Human Reproduction in New York says oral contraception use at the beginning of an IVF cycle has been the norm for a long time in the field of reproductive medicine. “Many physicians over time have used birth control as a way of regulating cycles or timing cycles to begin at a specific point so they are always starting IVF cycles at a particular time. Sometimes birth control is used for the convenience of the physicians and [fertility] centers if they do group IVF cycles with their patients,” he explains.
However he noticed that egg donors (young women more likely to use contraceptives prior to their egg donation cycle) had a lower level Anti Mullerian Hormone (AMH) and decreased response to ovarian stimulation than those who had not used birth control. AMH is an indicator of functional ovarian reserve, that is, the number of follicles likely to respond to stimulation in an IVF cycle. Environmental and biological factors such as contraceptive use or child birth can suppress a woman’s AMH and delay normal menses. Based on this evidence, Barad and his team designed a study to compare the effects of birth control suppression on the stimulation and retrieval outcomes of an IVF cycle.
They discovered that women who had used birth control at the beginning of an IVF cycle had poorer response to stimulation drugs and fewer eggs available for retrieval than those who had not used birth control. “Older, more androgenic birth control pills had more of a suppressive effect on AMH and fewer follicles during stimulation compared to those who did not use contraception or those who used less or anti-androgenic birth control pills. More modern birth control pills have less of an effect on ovarian reserve,” states Barad.
Based on the findings of this study, Barad suggests that IVF patients should use a less androgenic birth control pill or none at all to maximize the stimulation and retrieval outcomes of their cycle. “If we are going to use birth control pills, we have to be aware of who the patient is, the state of her ovarian reserve to begin with, and we don’t want to use birth control for too long,” he advises. An alternative would be to treat fertility patients with an estrogen patch priming protocol for ten days before beginning the cycle, a low dose Lupron protocol in conjunction with stimulation drugs at the beginning of the cycle, or prime the cycle with DHEA to prevent over-suppression.
These findings have yet to be replicated in women with diminished ovarian reserve, but this data along with knowledge of stimulation cycles in women with diminished ovarian reserve suggest a similar protocol would be recommended.