Birth control pills are one of the most popular and effective methods to prevent pregnancy when taken correctly. People will be surprised to know that birth control pills are also used in IVF to improve the chances of pregnancy.
How birth control pills affect the IVF cycle
Control The Cycle and Improve Response to Hormone Therapy
A typical IVF cycle begins with the administration of medications that stimulate and trigger the ovaries to release mature eggs. Once the mature eggs are collected, they are fertilized outside the body and become embryos. The embryos are then transferred into the uterus for implantation and pregnancy begins.
In many IVF protocols, there is a pre-stimulation step that occurs before the ovaries are stimulated with medications. The pre-stimulation step suppresses the women’s own natural hormones by using birth control pills. This is done for the following two reasons:
- Controlling the cycle. The doctors will be able to control the timing of the cycle through the use of birth control pills. This allows the clinic to avoid having too many patients with cycles that overlap, ensuring all patients receive the same quality of treatment and attention, and reduce scheduling conflicts.
- Improving the response to the hormone therapy. Birth control pills will help stimulate more eggs to mature at the same rate, resulting in more eggs being collected. It also decreases the chance of developing cysts (fluid‐filled sacs on the ovary), which is believed to reduce pregnancy losses and improve pregnancy outcome.
The continuing debate on using birth control pills in IVF
Possible Lower Rates of Live Births
The use of birth control pills in IVF cycle is not without controversy. There are debates on the efficacy of using birth control pills for pretreatment as contradictory data have been published on whether pretreatment with oral birth control pills have negative effects on IVF cycle outcome.
In 2015, there was a discussion between Juan A. Garcia-Velasco, Director of IVI-Madrid and Georg Griesinger, University Clinic of Schleswig-Holstein, Germany on the question “To pill or not to pill in GnRH antagonist cycles: that is the question!” The discussion concluded without a clear answer as there were not enough well designed and adequately powered studies to evaluate the efficacy of using oral birth control pill for pretreatment in IVF.
In 2017, a systematic review looked at 30 clinical trials assessing pretreatment with oral birth control pills in more than 5,000 women undergoing assisted reproductive technology and concluded that oral birth control pills for pretreatment was associated with lower rates of live birth than no pretreatment. However, the overall quality of the evidence from the trials ranged from very low to moderate, which made the conclusion on the efficacy of oral birth control pills for pretreatment weak.
The debate on the efficacy of using oral birth control pills for pretreatment in IVF will continue until better studies are available. Until then, the use of birth control pills in IVF will be based on the clinical judgment and experience of the fertility doctor.
Farquhar C, Rombauts L, Kremer JAM, et al. Oral contraceptive pill, progestogen or oestrogen pretreatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques. Cochrane Db Syst Rev. 2017; 5: CD006109. DOI: 10.1002/14651858.CD006109.pub3
Garcia-Velasco JA, Fatemi HM. To pill or not to pill in GnRH antagonist cycles: that is the question! Reprod Biomed Online. 2015; 30: 39–42.
Griesinger G, Venetis CA, Tarlatzis B, Kolibianakis EM. To pill or not to pill in GnRH-antagonist cycles: the answer is in the data already! Reprod Biomed Online. 2015; 31(1): 6-8.