Comparison of LH concentrations in the early and mid-luteal phase in IVF cycles after treatment with HMG alone or in association with the GnRH antagonist Cetrorelix

Abstract

Luteinizing hormone (LH) is mandatory for the maintenance of the corpus luteum. Ovarian stimulation for IVF has been associated with a defective luteal phase. The luteal phases of two groups of patients with normal menstrual cycles and no endocrinological cause of infertility were retrospectively analysed in IVF cycles. Thirty-one infertile patients stimulated with human menopausal gonadotrophins (HMG) for IVF to whom the gonadotrophin-releasing hormone (GnRH) antagonist Cetrorelix 0.25 mg was also administered to prevent the LH surge (group I) were compared with 31 infertile patients stimulated with HMG alone (group II). Despite differences in the stimulation outcome, luteal LH serum concentrations were similar in the two groups. LH values dropped from 2.3 +/- 1 IU/l on the day of human chorionic gonadotrophin (HCG) administration to 1.1 +/- 0.7 IU/l on day HCG +2 in group I (P < 0.0001) and from 5.1 +/- 3 to 1.2 +/- 1.7 IU/l (P < 0.0001) in group II. In the mid-luteal phase, LH concentrations were low in both groups. Our results suggest that suppressed LH concentrations in the early and mid-luteal phase may not be attributed solely to the GnRH-antagonist administration. Pituitary LH secretion may be inhibited by supraphysiological steroid serum concentrations via long-loop feedback and/or by the central action of the exogenously administered HCG via a short-loop mechanism.

The luteal phase of recombinant follicle-stimulating hormone/gonadotropin-releasing hormone antagonist in vitro fertilization cycles during supplementation with progesterone or progesterone and estradiol

“…In the present study, very low LH levels were present in both groups during the luteal phase, a finding that has been previously reported (22,23) and probably can be attributed to the high serum E 2 levels that are present in the luteal phase after ovarian stimulation for IVF. Because LH is mandatory for the maintenance and normal steroidogenic activity of the human corpus luteum (24), abnormal LH secretion may account for a defective luteal phase (22).…”

“…Because LH is mandatory for the maintenance and normal steroidogenic activity of the human corpus luteum (24), abnormal LH secretion may account for a defective luteal phase (22).…”

Efficacy of luteal phase support with vaginal progesterone in intrauterine insemination: a systematic review and meta-analysis

“…With reference to the ART, various mechanisms have been proposed to explain the luteal deficiency observed particularly in IVF cycles, although there is some controversy in the published literature [2][3][4][5][6]. Indeed, one can assume that multifollicular development and consequently the supraphysiological estradiol levels secreted by the multiple corpora lutea during the early luteal phase exert a negative feedback of the hypothalamicpituitary axis, inhibiting the LH release necessary for the corpus luteum function [7].…”

The early luteal phase administration of estrogen and progesterone does not induce premature luteolysis in normo-ovulatory women

“…(ii) Short-loop feedback by the late follicular phase bolus dose of hCG to induce final oocyte meiotic maturation. Although there were some indications of such an effect at the pituitary level suppressing gonadotropin release (31), this could not be confirmed by subsequent studies (28,29). (iii) Luteal phase defects can also be induced by stimulating multi-follicle development in normo-ovulatory volunteers (even without follicle aspiration), suggesting a correlation with the development of multiple follicles itself (32).…”

“…However, various studies in IVF applying GnRH antagonist co-treatment have now clearly established that luteolysis is also initiated prematurely under those conditions resulting in a significant reduction in luteal phase length and greatly compromised chances for pregnancy (27,28). More detailed studies could confirm that early-and mid-luteal phase LH levels remained suppressed following the follicular phase administration of GnRH antagonist (28,29).…”