Ovarian Cysts Formation During Depot Formulation of GnRH-a Therapy and the Effect of Pretreatment with Oral Contraceptive Pills on Subsequent Implantation and Pregnancy Rate in ART Cycles

Long protocol of Gonadotropin-Releasing Hormone-analougue (GnRH-a) can result in the formation of ovarian cyst by the transient initial stimulatory effect which increases the levels of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These cysts require surgical drainage or result in poor ovarian response. Ovarian cyst formation can be prevented by taking oral contraceptives (OCs) which suppress LH and FSH after initiation of GnRH-a therapy. This study was designed to investigate ovarian cyst formation during therapy with depot formulation of GnRH-a and also the effect of taking (OCs) before starting the treatment with depot formulation of GnRH-a, on the formation of ovarian cyst, implantation and pregnancy rate in assisted reproductive tecnique (ART) cycles. Fifty four infertile women who were candidate for ART, underwent two treatment protocols in a prospective randomized trial: (a) OC+HMG+diphereline and (b) HMG+diphereline. In group (a) patients were pretreated with OC for 14 days starting from the first day of mensturation and on the day 14 received 3.75 mg IM depot diphereline. Patients in group (b) received 3.75 mg diphereline by intramuscular injection on the second day of menstruation. Sonography was performed on the first day of menstruation and also 7 and 14 days after diphereline injection. Ovarian cyst incidence, gonadotropin consumption, follicular growth, implantation rate and pregnancy in the two groups were studied. No ovarian cyst with diameter over 26 mm was developed with depot formulation of GnRH-a in any of the two groups (a and b). There was no significant difference between the two groups in the follicular growth (9.2±2.1 and 9.4±2.9), number of oocyte (5.0±2.8 and 5.4±5.7), implantation rate (0.02­±0.08 and 0.03±0.10) and pregnancy rate (0.09 and 0.11). We divided the patients into two groups based on their ages: (20-34) and (≥35). It showed no significant difference in the gonadotropin consumption, mean number of follicles and mean number of embryos in groups (a and b) based on their ages. No ovarian cyst developed with depot formulation of GnRH-a. So, in women with a history of ovarian cyst formation in previous cycles depot form of GnRH-a may be considered. Pretreatment with OCs during therapy with depot formulation of GnRH-a and gonadotropin didn’t increase the number of oocyte, implantation rate and pregnancy