The question
Dear Dr Sher,
You have written that pre-antral follicles require exposure to FSH for 5 - 7 days to be able to develop into Antral Follicles. However, taking Birth Control Pills (BCPs) prior to COS suppresses FSH, and therefore does not allow PAF-AF conversion. This could lead to both follicle and egg development being compromised. Therefore, women who take BCPs to launch a cycle of COS need to have an overlap of the BCP with an agonist, because the agonist would cause an immediate surge in release of FSH by the pituitary gland thus causing conversion from PAF to SAF.
My question is - can the same not be achieved by overlapping the BCP with small (or large) amounts of Gonal-F for a few days?
Furthermore, you also suggest that women need exposure to small amounts of LH to produce testosterone, which in turn is converted into Estradiol. Therefore, for women taking BCPs prior to COS, would they also not see a suppression of LH? and as a result, there would be a hindrance to follicle and egg growth?
In this case, rather than overlapping BCP with agonists, can the patient overlap BCP with Menopur (to get just the right amount of FSH and LH) in the system?
Thank you.
Answer from Dr. Geoffrey Sher
Thank you for your very thought provoking comments and questions.
Frankly, I cannot disagree that administration of FSH-in small amounts over the last few days of the BCP might not have a similar effect to overlapping with Lupron. It might however add an additional unnecessary variable and expense. Frankly I have never tried this!! It is certainly worth evaluating...Thank you.
As for the concern that the BCP might suppress conversion to AFC's. That would not likely happen.
Finally, the moment the BCP is stopped (at the point of conversion to gonadotropins, the production of LH resumes somewhat , adding sufficient LH and of course, the addition of Menopur (in small amounts) which contains LH , also addresses this. Besides, remember, the ovarian testosterone is only needed once stimulation begins with gonadotropins.
General information only, not medical advice for your own situation. For that, book a consultation.