Combined oral contraceptive pills (COCPs) administered prior to ovulation induction in IVF increase the number of oocytes retrieved and suppress cyst formation.9,10,11 In a small study of poor responders undergoing controlled ovarian hyperstimulation for IVF, pretreatment with COCPs was associated with increased pregnancy rates compared to pretreatment with luteal phase gonadotropin releasing hormone agonist (GnRH-a), follicular phase GnRH-a, and no pretreatment.12 COCPs prior to ovulation induction with microdoses of GnRHa and gonadotropins enhance ovarian responsiveness in poor responders resulting in higher peak estradiol (E2) levels, more mature follicles, and larger number of retrieved oocytes when compared with traditional luteal GnRH-a downregulation followed by gonadotropin stimulation.13 Follicular GnRH-a administration releases endogenous gonadotropins producing a gonadotropin "flare" effect. Smaller, more frequent "microdosing" of GnRH-a minimizes endogenous FSH suppression while preventing premature luteinizing hormone (LH) surges. Oral contraceptive pretreatment prevents formation of a corpus luteum that could produce progesterone prematurely during the flare. This protocol with the addition of growth hormone (GH) has been shown to produce a 50% ongoing pregnancy rate (PR) when used in patients who had prior ovulation induction cycles using luteal phase GnRH-a suppression followed by exogenous gonadotropins and GH cancelled due to poor response.14