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Launching Controlled Ovarian Hyperstimulation Off the Birth Control Pill
by Geoffrey Sher
If you are cycling naturally, a rise in FSH takes place as the Corpus luteum begins to die, a few days before the end of a cycle. This serves as a trigger that recruits follicles making them available for the ensuing menstrual cycle. Without FSH triggering, no follicles are recruited in which case stimulation is more likely to fail. The birth control pill (BCP) blocks ovulation, suppresses FSH and thus if you come directly off the BCP and go on to Gonadotropin stimulation, you do so without having recruited follicles in advance and the stimulation cycle is often a disaster. Remember, a proper response to stimulation with gonadotropins requires that recruited antral follicles be available and ready. So you can now see why starting your stimulation coming off a BCP might not have been ideal.
By the way, there is nothing wrong with using the BCP before a cycle of stimulation. We do this all the time and in fact feel that it might even be superior to initiating stimulation coming of a natural cycle. However, when using the BCP we always overlap it a GnRH agonist (e.g Lupron) during the last few days on the BCP. The Lupron immediately expunges a large amount of your body's own FSH into the circulation and this serves to recruit follicles for the upcoming stimulation with gonadotropins.
The message? If a woman goes in to stimulation coming off the birth control pill, a GnRHa should be overlapped with the pill for a few days before the stimulation begins. If this is done the BCP will NOT suppress response to ovarian stimulation with gonadotropins.