Is there a relationship between luteinizing hormone levels and ART outcome in GnRH antagonist protocols? A retrospective cross-sectional study

Abstract

Objective: To evaluate the potential link between serum LH concentrations on the day of oocyte triggering and pregnancy outcome during controlled ovarian hyperstimulation. Materials and Methods: In this retrospective cross-sectional study, data of women ≤42 years undergoing fresh embryo transfer cycles and who had downregulated with GnRH antagonist protocol in a 12-month period was reviewed. Patients with incomplete hospital records were excluded. Women were divided into four groups based on the percentiles of the serum LH level on the day of oocyte triggering: <1.49 (<25 th percentile), 1.49–2.59 (25–50 th percentile), 2.60–4.60 (50–75 th percentile), and >4.60 IU/L (>75 th percentile). Clinical pregnancy was considered the primary outcome, while chemical pregnancy and implantation rate were the most important secondary outcomes which were compared between the four groups. Results: Four hundred and nighty-three women of 1003 infertile women, who were initially assessed for eligibility, met the inclusion criteria. Finally, 426 women were analyzed. Levels of progesterone were significantly correlated with the level of LH on the day of trigger in the >4.60 IU/L group ( r = 0.20, P = 0.034). Furthermore, the levels of estradiol were significantly correlated with the level of LH on the day of trigger in the <1.49 IU/L ( r = 0.21, P = 0.026). The number of retrieved oocytes, 2PNs (two pronucleis), number, and quality of total embryos were similar between groups ( P > 0.05). With regard to oocyte maturity rate, fertilization proportion, fertilization rate, chemical pregnancy rate, and clinical pregnancy rate, there was no difference between varied LH levels in the four groups ( P > 0.05). The only observed difference was the implantation rate that was significantly higher in the 2.60–4.60 IU/L group than the <1.49 IU/L group ( P < 0.05). Conclusions: Our result could not show the potential link between LH concentrations during GnRH antagonist cycles and pregnancy outcomes. However, very low LH levels during ovarian stimulation period may negatively affect the implantation rate.

Association between luteinizing hormone level decrease on the triggering day and pregnancy outcome for in vitro fertilization/intracytoplasmic sperm injection patients following gonadotropin-releasing hormone antagonist protocol: a retrospective cohort study

“…However, Depalo et al reported that patients with positive pregnancy test results had significantly lower LH levels at the beginning of the stimulation period and lower LHLOT [28] . Eftekhar et al found that LHLOT <1.49 may negatively affect the implantation rate rather than the clinical pregnancy rate [29] . Moreover, Merviel et al found that LHLOT >0.5 or ≤0.5 IU/L had no impact on oocyte yield and clinical pregnancy rates [17] .…”

“…Merviel et al [17] GnRH-A ≤0.5 >0. 5 No influence (119) (151) Benmachiche et al [18] Eftekhar et al [29] GnRH-A <1.49 [53] GnRH-a down-regulation <0.5 >0.5 LH < 0.5 IU/L increased risk of early pregnancy loss (98) (102) Balasch et al [60] GnRH-a down-regulation <1 (44) or ≤0.7 (21) or ≤0.5 (10) or >0.5 (134) No influence ≥1 (100) >0.7 (123) Humaidan et al [54] GnRH-a down-regulation <0.5 0.51-1.0…”