A protocol for ovulation delay in women who cannot use estrogen, including Jewish women with Niddah issues and a pilot study.

Orthodox Jewish women abstain from sexual intercourse from the commencement of menstruation until seven days after the end of menstrual bleeding at which point they can immerse themselves in a ritual bath and recommence relations. For women who ovulate prior to commencing intercourse this results in religious infertility. The traditional treatment for religious infertility is oral estrogens in the early follicular phase to delay ovulation. However, certain groups of women have contraindications to oral estrogens. In this group, no treatment options have existed until now. In this study we proposed a treatment protocol substituting the use of gonadotropin releasing hormone-antagonists in the early follicular phase for the oral estrogens. In a small pilot study, we demonstrate that these two protocols have similar outcomes in terms of ovulation delay (p = 1.0) and likelihood of ongoing pregnancy (p = 1.0). This protocol for ovulation delay also has applications in non-Jewish women who need to delay ovulation due to life constraints.