Can we use OCP as preteatemnt before CC?? A) Pretreatment with combination oral contraceptives (OC) the cycle before taking CC

Bad PCO !!! Pretreatment is essential to decrease the levels of elevated androgens and LH .Pretreatment with OCP and  followed by agonist. -pretreatment is essential to decrease the levels of elevated androgens and LH. A prolonged OCP may be needed if late luteal agonist is not used

OCP- Diane –Yes or no?? : Many follow the age old policy of prescribing first three consecutive cycles of Diane-35 prior to gonadotrophin induction. But recently this policy has debated by some as such researchers feel that use of COC may have an unfavorable effect of on endometrium. But on the whole ,many however still  use  ocps for all pts  of PCO prior to stimulation  except poor responders . That’s true most of the people are not using COCs prior to antagonist cycles.

How to curtail basal LH?? OCP   were prescribed to minimize LH  &  Androgens too . Later to further minimize LH another dose of Cetrolix (first dose of antagonist ) may be administered. This ensures complete down regulation. Subsequently from day 4 daily administrations of gonadotropins and Cetrolix may continue. By and large the common principle is to supplement, antagonists from late follicular phase of stimulation to prevent premature LH surge, but proponents of who use from the initial days of follicular phase along with gonadotrophins argue that tonic raised LH can be better tackled if antagonists are used at the early follicular phase. Members opinion please??  .

A)              To counteract tonic LH raised it is now hypothesized that Antagonists should be administered on Day3 of cycle induced after three cyclical Diane courses.

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It is called as Diane/Cetrolix protocol.:- Three cycles of Diane protocol followed by on day 3 Cetrolix. From day 4 daily gonadotrophins and daily Cetrolix were administered till day of HCG administration. High LH in follicular phase, raised intraovarian androgens, hyperinsulinaemia, all favours abnormal growth of follicles. Even in RPL cases the androgen levels are higher than control cases. At least two weeks down regulation (d/R)  is needed by agonist before the stimulation can be started. Adjunctive treatment

What kind of OCP is better to decrese androgens and  LH?? Combination OCs containing 30-35 μg estradiol are more effective than combination OCs containing 20 μg estradiol or multiphase OCs for most patients Pretreatment with oral contraceptive

A)              Pretreatment with combination oral contraceptives (OC) the cycle before taking CC significantly increased ovulation rates and pregnancy rates in a systematic review of randomized controlled studies. Multiple pregnancy rates were also increased. Combination OCs containing 30-35 μg estradiol are more effective than combination OCs containing 20 μg estradiol or multiphase OCs for most patients, but may reduce follicle development in a few patients. Pretreatment with OCs is particularly beneficial in PCOS patients, because they suppress serum and ovarian androgen levels