Low LH Level on the Day of GnRH Agonist Trigger Is Associated With Reduced Ongoing Pregnancy and Live Birth Rates and Increased Early Miscarriage Rates Following IVF/ICSI Treatment and Fresh Embryo Transfer

Abstract

Objective: To examine the correlation between serum luteinizing hormone (LH) levels on the day of GnRH agonist (GnRH-a) trigger and reproductive outcomes following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment and fresh embryo transfer, and to identify a pre-trigger serum LH threshold which would be compatible with the most optimal cycle outcome.Design: This study is based on data from a previously published randomized controlled trial conducted from 2014 to 2016.Patients: A total of 322 participants were enrolled.Setting: Private IVF center. Intervention(s): GnRH-antagonist-based IVF cycles triggered with GnRH-a. For the purpose of the study, patients were stratified according to preovulatory LH quartiles (Q1-Q4). Main Outcome Measure(s): Ongoing pregnancy rates (OP), live birth rates (LB) and early pregnancy loss (EPL) rates.Results: The results of the present study showed increasing OP as well as LB rates and decreasing EPL rates with increasing pre-trigger serum LH levels (P for trend < 0.06, 0.07, and 0.02), respectively. The absolute difference between the highest LH(Q4) and the lowest LH (Q1) group was 13.4%, 12.1%, and 12% in OP, LB, and EPL rates, respectively. In multivariate regression analysis, a pre-trigger serum LH level of 1.60 mIU/ml was identified as a threshold below which reproductive outcomes decreased. The ROC curve values were statistically significant for OP, LB, and EPL; the AUC (95% CI) = [0.57 (0.50–0.63) P < 0.04; 0.57 (0.50–0.63) P < 0.05, and 0.60 (0.51–0.70) P < 0.04], respectively. A significant positive correlation was found on the day of GnRH-a trigger between serum LH, the number of follicles, serum P4, and serum E2, p < 0.03; P < 0.03; and P < 0.001, respectively.Conclusion: Low serum LH levels on the day of GnRH-a trigger is associated with reduced ongoing pregnancy and live birth rates and increased early miscarriage rates. Our findings suggest a lower threshold of serum LH values on the day of GnRH-a trigger necessary to optimize reproductive outcomes in fresh embryo transfer cycles.Clinical Trial Registration: www.ClinicalTrials.gov, Number: 02053779

Roles of estradiol levels on the day of human chorionic gonadotrophin administration in the live birth of patients with frozen embryo transfer

“…Previous studies showed that the alterations of these hormones such as basal LH, basal PRL, and basal P levels were associated with pregnancy in embryo transfer 37‐39 . In our study, there were no statistical differences in the levels of basal LH, basal PRL, and basal P between the live‐birth group and the no‐live‐birth group.…”

Low Serum LH Levels During Ovarian Stimulation With GnRH Antagonist Protocol Decrease the Live Birth Rate After Fresh Embryo Transfers but Have No Impact in Freeze-All Cycles

“…Some authors failed to find any significant difference between different LH groups regarding the implantation rates, clinical pregnancy rates, and ongoing pregnancy rates (13,15). However, in a recent study by Benmachiche et al (24), low serum LH levels on the day of GnRH-agonist trigger are associated with reduced rates of live birth and increased early miscarriage rates. The variety in the definition of low LH, measurement parameters of LH, and the clinical interventions may explain this inconsistent.…”

Reduced FSH and LH action: implications for medically assisted reproduction

“…Usually, the residual circulating levels of LH are sufficient to support steroidogenesis in theca cells, and recombinant human FSH (r-hFSH) is sufficient for OS. However, LH levels much lower than baseline can negatively affect MAR outcomes in some women ( Westergaard et al , 2000 ; Huirne et al , 2005 ; Lahoud et al , 2006 ; Kol, 2014 ; Chen et al , 2016 ; Benmachiche et al , 2019 ).…”