Effects Of Oral Contraceptives On Ovulation Induction In In Vitro Fertilization Patients With Premature Ovarian Insufficiency

Background: Premature ovarian failure(POF)or premature ovarian insufficiency(POI),is defined as a disease with the loss of ovarian function before age 40 years.Its prevalence is 1% by age 40 years and 0.1% by age 30 years.POI is associated with chromosomal and genetic disorders,iatrogenic injury or autoimmune diseases;however,the cause is often unknown in the majority of patients.Ovarian activity of POF is often intermittent in many patients,and there is a small possibility of spontaneous pregnancy 5-10%,with a low live birth rate <1%.Various forms of ovarian stimulation protocols have been applied to enhance their reproductive outcome but remain highly controversial.Such treatments include estrogen replacement therapy for ovarian sensitization,exogenous gonadotropins for ovarian stimulation,oral contractive for pituitary suppression,adjuvant therapy of traditional Chinese medicine(acupuncture and Chinese Medicine).In fact,no therapy mentioned above has been demonstrated effective by power study.At present,the treatment of premature ovarian failure is mainly based on hormone replacement therapy to relieve the climacteric symptoms.It is necessary to explore a protocol to improve the fertility of patients with POF.Objective: To evaluate the effect of contraceptive in ovulation induction in patients with premature ovarian failure,and to summarize the characteristic of patients and protocol and the outcome of pregnancy.Methods: Retrospective analysis twenty-two women with POF who presented to the Reproductive Medicine Center of Navy General Hospital to seek pregnancy.All patients agreed to refer to IVF-ET techniques.Women with POF take oral contraceptive pills orally to suppress high level of FSH and LH before embarking on stimulation.During this period,transvaginal ultrasounds and biochemical examinations were performed at 5 to 10 day intervals to find the potential follicles.When the follicles were found,the Yasmin doses could be halved or quartered to increase and keep the FSH levels at around 10 to 25 U/L,with or without ovarian stimulation.When a follicle exceeded a mean diameter of 14 to 18 mm and serum E2 was 150 to 250 pg/m L,h CG was given,and a transvaginal oocyte retrival followed 24 to 36 hours later.Exogenous gonadotropin was added when FSH is lower than 10U/L and the presence of 2-3 follicles were detected.Result(s): There were total 106 OC treatment cycles in the 22 patients,and there were 62 mature follicle growths cycle cycles,53 oocyte retrival cycles in 20 patients(91%,20/22).The total number of oocytes retrieved was 48 in 17 patients(77%,17/22),and the total number of embryos frozen was 33 in 16 patients(73%,16/22).Preliminary results of FET were as follows: two gave a baby,two were ongoing pregnancy,three women not achieved pregnancy;two women were confirmed clinical pregnancy and later suffered spontaneous abortion.Conclusion(s): The use of oral contraceptives can reduce FSH levels efficiently and consistently and hormone down-regulation therapy can be a choice when other common stimulation protocols and medication are difficult to start.