This chapter reviews the role of gonadotropin-releasing hormone (GnRH) antagonists in ovulation induction for in vitro fertilization (IVF). Although the purpose of the development of GnRH antagonists was originally a non-steroid contraceptive drug, it was found that GnRH antagonists have potential benefit in assisted reproduction. GnRH antagonists act by immediate suppression of pituitary gonadotropin release and rapid recovery of normal secretion of endogenous luteinizing hormone (LH) and follicle stimulating hormone (FSH). The inhibition of LH secretion is more pronounced than that of FSH, this being most likely due to the different forms of gonadotropin regulation and the prolonged FSH half-life, or the immunoactive and bioactive forms of FSH. The effect of oral contraceptive pills (OCP) for cycle scheduling prior to GnRH antagonist protocol on IVF cycle parameters and pregnancy outcome was studied. All OCP-pretreated cycles required significantly longer stimulation than non-pretreated cycles and higher total dosage of FSH.

Contraception is an inherent part of good health care for women. Emergency contraception (EC) is birth control used to prevent pregnancy after known or suspected failure of contraception or unprotected intercourse, including sexual assault. Women who use EC should be given additional opportunities to consider whether a more permanent or better method of contraception is warranted. Once adolescents have had a sexual experience, they may be even more open to reconsidering abstinence and should be encouraged to consider abstinence as a potential choice. Certain types of condoms provide some protection against sexually transmitted infections. Oral contraceptive pills (OCPs) are hormonal methods of birth control. For most women, pregnancy and/or abortion are associated with a greater risk of mortality and morbidity than oral contraceptives. Male sterilization is the most cost-effective contraceptive method, with a failure rate of 0.1 to 4%. Many circumstances affect a woman's access to contraception.

This chapter discusses polycystic ovary syndrome (PCOS) and its clinical manifestations. It also explores the incidence of insulin resistance in PCOS. Insulin resistance can be encountered in women with PCOS. Diagnosis and treatment are also independent on insulin resistance. Management of women with PCOS depends on the symptoms. These could be ovulatory dysfunction-related infertility, menstrual disorders, or hirsutism. Treatment of hirsutism involves administration of oral contraceptive pills and antiandrogens. Clomiphene citrate, dexamethazone, gonadotropin and aromatase inhibitors are used in the treatment of ovulatory disorders. Gonadotropin-releasing hormone agonist plays a major role in IVF treatment as well as in superovulation. There are several insulin-sensitizing agents available to reduce insulin levels, and the most commonly used for women with PCOS is metformin. Metformin has replaced the surgical treatment of PCOS with ovarian drilling. Metformin improves insulin resistance and hyperandrogenism, decreases serum lipids, and improves glucose homeostasis.