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 inthe formation of ovarian cyst by the transient initial stimulatory effect which increases thelevels of both foilicle-stimulating hormone (fsh) and luteinizing hormone (lh). these cystsrequire surgical drainage or result in poor ovarian response. ovarian cyst formation can beprevented by taking oral contraceptives (ocs) which suppress lh and fsh after initiation ofgnrh-a therapy. this study was designed to investigate ovarian cyst formation during therapywith depot formulation of gnrh-a and also the effect of taking (ocs) before starting thetreatment with depot formulation of gnrh-a, on the formation of ovarian cyst, implantationand pregnancy rate in assisted reproductive tecnique (art) cycles. fifty four infertile womenwho were candidate for art, underwent two treatment protocols in a prospective randomizedtrial: (a) oc+hmg+diphereline and (b) hmg+diphereline. in group (a) patients werepretreated with oc for 14 days starting from the first day of mensturation and on the day 14received 3.75 mg 1m depot diphereline. patients in group (b) received 3.75 mg dipherelineby intramuscular injection on the second day of menstruation. sonography was performed onthe first day of menstruation and also 7 and 14 days after diphereline injection. ovarian cystincidence, gonadotropin consumption, foilicular growth, implantation rate and pregnancy inthe two groups were studied. no ovarian cyst with diameter over 26 mm was developed withdepot formulation of gnrh-a in any of the two groups (a and b). there was no significantdifference between the two groups in the foilicular growth (9.2(plus-minus)2.1 and 9.4(plus-minus)2.9), number ofoocyte (5.0(plus-minus)2.8 and 5.4(plus-minus)5.7), implantation rate (0.02(plus-minus)0.08 and 0.03(plus-minus)0.10) and pregnancyrate (0.09 and 0.11 ). we divided the patients into two groups based on their ages: (20-34) and((greater than or equal)35). it showed no significant difference in the gonadotropin consumption, mean number offollicles and mean number of embryos in groups (a and b) based on their ages. no ovarian cystdeveloped with depot formulation of gnrh-a. so, in women with a history of ovarian cystformation in previous cycles depot form ofgnrh-a may be considered. pretreatment with ocsduring therapy with depot formulation ofgnrh-a and gonadotropin didn't increase the numberof oocyte, implantation rate and pregnancy.