Why are contraceptives taken before IVF? How many days?

By (gynecologist), (gynecologist), (gynecologist) and (embryologist).
Last Update: 06/15/2023

The contraceptive pill is well known and widely used to prevent unwanted pregnancy. For this reason, many women are surprised when the specialist prescribes oral contraceptives just before starting in vitro fertilization(IVF).

However, although it may seem contradictory, taking contraceptives before the IVF cycle, as indicated by the gynecologist, has an explanation. However, not all women who are going to undergo an IVF cycle take contraceptives, but the specialist evaluates when it is appropriate according to the particular situation.

Reasons for prescribing contraceptives prior to IVF

There are occasions when the gynecologist instructs the woman to take birth control pills before starting the ovarian stimulation of an in vitro fertilization (IVF) cycle. This often comes as a surprise to women, since IVF is an assisted reproduction treatment that is performed precisely to try to achieve pregnancy.

Oral contraceptives usually contain estrogens and progesterone, i.e., they are combined. Both hormones are very important in the regulation of a woman's menstrual cycle. Therefore, when oral contraceptives are administered exogenously, the specialist has greater control over it.

Therefore, the gynecologist may decide to prescribe oral contraceptives before an IVF cycle for reasons such as the following:

  • To regulate the onset of menstruation in patients who have an irregular menstrual cycle.
  • Inhibit ovarian function so that the ovaries are at rest at the start of ovarian stimulation treatment. For example, if any persistent follicle or follicular cyst is observed and to avoid possible asynchrony in follicular development during stimulation, which would affect the results.
  • Facilitate the scheduling of important dates in assisted reproduction treatment, in patients who need more planning.

The specialist will assess whether taking oral contraceptives prior to the IVF cycle is the most indicated. Because of this, contraceptives are not prescribed for all women undergoing IVF, but only when it is appropriate for the patient's particular situation.

How many days are contraceptives taken before IVF?

If the specialist instructs the patient to take oral contraceptives before IVF (since they are not necessary in all cases), it is usual to start taking them in the first days of menstruation (from the first to the third day), after an ultrasound check-up. In the same way, it is most usual to take them for approximately two weeks, although it will depend on each particular case.

After this period of about 15 days with contraceptives, the gynecologist will confirm by ultrasound and/or hormone analysis that the ovaries are at rest. In this case, the woman will stop taking the contraceptive and, after a rest period of about five days, she will be able to start the established ovarian stimulation protocol.

However, it is important to always follow the guidelines indicated by the specialist, since he/she is the one who knows the patient's particular situation.

You can read more information about the process of ovarian stimulation in the following link: What is ovarian stimulation - Process, medications and symptoms.

FAQs from users

Are birth control pills always given before fertility treatment?

By Manuel Aparicio Caballero M.D., M.Sc. (gynecologist).

Not necessarily. An ovarian stimulation cycle can start between the 1st and 4th day of the period without using contraceptives. However, they have many uses in our specialty.

Contraceptives can be given because a follicular cyst (also called a persistent follicle) is observed before performing ovarian stimulation. In this case, they are used for at least 14-15 days to reduce the follicle and leave the ovaries in a basal state, ready to start ovarian stimulation. They are also very useful in patients with endometriosis since, in some cases, they can reduce the symptoms and size of some endometriomas.

One of the main advantages of contraceptives is that they reduce the risk of asynchrony occurring during ovarian stimulation. An asynchrony is nothing more than the accelerated growth of a few follicles and, consequently, a worse result when performing the ovarian puncture. This would cause the collection of many fewer oocytes than would correspond to the patient and a suboptimal result.

Another advantage is that they help plan the start of ovarian stimulation and therefore the distribution of the workload of assisted reproduction centers. However, overusing contraceptives for more than 2 weeks prior to ovarian stimulation may result in a slower response and poorer results.

Is it common to use the contraceptive ring before fertility treatment instead of pills?

By Amanda Olinda Sinchitullo Rosales M.D., M.Sc. (gynecologist).

Before the first step in IVF or ICSI (hormone therapy) cycles, a pre-treatment with a contraceptive can be administered, most often an oral contraceptive.

A COC (combined oral contraceptive) contains both progestogen and oestrogen, as does the vaginal ring which could also be used prior to fertility treatment.

A pre-treatment with a progestogen or oestrogen alone could also be implemented before hormone therapy. These pre-treatments suppress the production of hormones by the patient. Therefore, they may improve the woman's response to hormone therapy in IVF/ICSI cycles. In this way, adverse events such as cyst formation (fluid-filled sac that develops in the ovary) and the number of pregnancy losses could be reduced, and pregnancy outcomes could be improved.

Do antibiotics influence contraception before IVF?

By Paloma Sánchez Gómez M. D. (gynecologist).

On some occasions, before performing an assisted reproduction technique, especially in vitro fertilisation, the gynaecologist prescribes a contraceptive pill from the first days of the period of the previous cycle.

In the event that the patient requires antibiotic treatment during the same period, due to a bacterial infection, it is common for the woman to be concerned about whether there is an interaction between the two drugs that could harm the effectiveness of her reproductive treatment. However, for most commonly used antibiotics, there is no solid scientific evidence to show a reduction in the efficacy of hormonal contraceptives, with one exception, rifamycin such as rifampicin or rifabutin, commonly used in the treatment of tuberculosis.

In any case, as I mentioned before, before starting the IVF cycle we will always check beforehand that it is the right time to start, so if the antibiotic has influenced the absorption of the contraceptives, we would detect it before starting the IVF cycle.
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Is contraception given before IVF with donor eggs?

By Silvia Azaña Gutiérrez B.Sc., M.Sc. (embryologist).

Yes, it is possible that the gynaecologist may instruct the recipient woman to take oral contraceptives before IVF with donor eggs or egg donation, especially if it is a fresh egg donation.

The reason for prescribing contraceptives is that, in this case, it is necessary to synchronise the recipient woman's menstrual cycle with that of the donor. For this reason, it is common for a contraceptive to be taken, which will facilitate this coordination.

Subsequently, the donor will begin ovarian stimulation, while the recipient will begin endometrial preparation. Thus, the recipient's uterus will be prepared on the day of the embryo transfer.

Suggested for you

If you want to know more about IVF, we recommend you to visit this link: In vitro fertilization (IVF): What is it and how much does it cost?

On the other hand, if you want to know more about oral contraceptives, you can read the following article: What is the contraceptive pill - Efficacy, how to take it, and risks.

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Shahrokh Tehrani Nejad E, Bakhtiari Ghaleh F, Eslami B, Haghollahi F, Bagheri M, Masoumi M. Comparison of pre-treatment with OCPs or estradiol valerate vs. no pre-treatment prior to GnRH antagonist used for IVF cycles: An RCT. Int J Reprod Biomed. 2018 Aug;16(8):535-540. PMID: 30288488; PMCID: PMC6163045. (View)

Zhu S, Lv Z, Song L, Zhang Q, Fan Y, Li J. Estradiol pretreatment in GnRH antagonist protocol for IVF/ICSI treatment. Open Med (Wars). 2022 Nov 21;17(1):1811-1820. doi: 10.1515/med-2022-0594. PMID: 36457798; PMCID: PMC9679556. (View)

FAQs from users: 'Are birth control pills always given before fertility treatment?', 'Is it common to use the contraceptive ring before fertility treatment instead of pills?', 'Do antibiotics influence contraception before IVF?' and 'Is contraception given before IVF with donor eggs?'.

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Authors and contributors

 Amanda Olinda  Sinchitullo Rosales
Amanda Olinda Sinchitullo Rosales
M.D., M.Sc.
Amanda Sinchitullo Rosales graduated in Medicine and is specialized in Obstretrics and Gynecology developed in the Hospital Complex of A Coruña. She holds also a Master's degree in Human Reproduction from the Complutense University of Madrid and currently works in the clinic FIVMadrid Valladolid. More information about Amanda Olinda Sinchitullo Rosales
Licence number: 471511813
 Manuel Aparicio Caballero
Manuel Aparicio Caballero
M.D., M.Sc.
Bachelor's Degree in Medicine from the University of Murcia. Specialist in Obstetrics & Gynecology. Master's Degree in Human Reproduction from the King Juan Carlos University and the IVI. More information about Manuel Aparicio Caballero
License: 303008030
 Paloma Sánchez Gómez
Paloma Sánchez Gómez
M. D.
Dr. Sánchez-Gómez has a degree in Medicine and Surgery from the Complutense University of Madrid. She also has a Master's degree in Assisted Reproduction from the Universidad Rey Juan Carlos de Madrid and a degree in Clinical Genetics in Assisted Reproduction from the Universidad Miguel Hernández de Elche. More information about Paloma Sánchez Gómez
Member number: 282863971
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
B.Sc., M.Sc.
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV

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