Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF

Kolibianakis, Efstratios M.; Zikopoulos, Konstantinos; Schiettecatte, Johan; Smitz, Johan; Tournaye, Herman; Camus, Michel; Steirteghem, A.C. Van; Devroey, Paul

doi:10.1093/humrep/deh471

Cited by 94 publications

(49 citation statements)

References 34 publications

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“…The highest implantation rate and ongoing pregnancy rate was present in those patients with LH levels on day 8 of stimulation ≤0.5IU/l. 16 In another study by Howles C M et al, in women undergoing IVF treatment with a combination of CC and hMG, there were no pregnancies recorded if the urinary output of LH was elevated when measured two days prior to the day of hCG administration. 5 Moreover, Stanger and Yovitch, have reported that high concentrations of luteinising hormone in the few days before oocytes were collected from women for in vitro fertilisation were associated with impaired rates of fertilisation and conception.…”

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confidence: 97%

The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome

Shanmugham

Vidhyalakshmi

Shivamurthy

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONPolycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in infertile women. Infertility affects 40% of women with PCOS.1 Polycystic ovary syndrome (PCOS), a relatively common reproductive endocrine disorder often associated with high endogenous LH secretion, menstrual cycle disorders, infertility and high rates of spontaneous abortion, was considered the paradigm condition that proved the potential untoward actions of LH.Raised tonic levels of luteinizing hormone (LH) is one of the main endocrinological disturbances in PCOS patients.2 This inappropriate secretion of LH seems to affect both fertility and pregnancy outcomes of PCOS women. Increased production of androgens associated with high LH concentrations, coupled with their inefficient aromatization to estrogens related to the low FSH levels in PCOS patients, results in local androgen excess and oestrogen deficit within the ovary.3 This would constitute a potent androgenic environment for the follicle leading to cessation of follicular growth. This ABSTRACT Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in infertile women. Raised tonic levels of luteinizing hormone (LH) is one of the main endocrinological disturbances in PCOS patients. Objective of present study was to evaluate the effect of baseline serum luteinizing hormone levels on follicular development, ovulation and conception and pregnancy outcome in infertile patients with PCOS. Methods: This is a prospective study conducted on 50 consecutive infertile patients with PCOS. Baseline Day 2 serum luteinizing hormone concentration was done in selected patients. Ovulation induction was done with clomiphene citrate 100 mg from Day 3 to Day 7 of the cycle. Then patients were monitored for follicular development, ovulation, conception and early pregnancy loss. Results: The mean age of the patients is 25±3.6 yrs. The average duration of infertility is 5.4 yrs (2-10). The mean basal serum LH concentration in patients who ovulated was significantly low (5.6 IU) in comparison with patients who did not ovulate (10.1 IU). The mean basal serum LH concentration in patients who conceived was 3.9 IU in comparison with patients who did not conceive (5.9 IU) which was statistically significant (p=0.04). Out of 15 patients who conceived, 3 patients (20%) had early pregnancy loss. Conclusions: Tonic hyper secretion of LH results in premature oocyte maturation, causing the problems with fertilization and miscarriage. Inappropriately raised LH appears to have deleterious effects on the pregnancy outcome.

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confidence: 97%

The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome

Shanmugham

Vidhyalakshmi

Shivamurthy

2017

Int J Reprod Contracept Obstet Gynecol

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“…An alternative to GnRH agonists, GnRH antagonists have been proposed to prevent premature LH surge [ 16 ]. These drugs do not produce fl are-up effect, reducing synchronous follicular pool recruitment.…”

Section: Ovulation Induction and Intrauterine Insemination (Iui)mentioning

confidence: 99%

Ultrasound in Follicle Monitoring for Ovulation Induction/IUI

Blankstein

Malepati

Brasch

2013

Ultrasound Imaging in Reproductive Medicine

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“…As a consequence, the oocyte/follicle unit may undergo dramatic and potentially detrimental changes due to the hormonal environment. On the other hand, a significantly higher pregnancy rate was described in patients with profound LH suppression (≤0.5 IU/l) on day 8 of stimulation (prospective, n = 116, r-hFSH 200 IU fixed from cycle day 2 and daily 0.25 mg GnRH antagonist from day 6 of stimulation) [62]. Some clinical trials have been designed in order to investigate the efficacy of LH supplementation in different subsets of patients treated with GnRH antagonists (Table 2) [63][64][65].…”

Section: Importance Of Flexible Lh Administration During Ovarian Stimmentioning

confidence: 99%

Is there a Need for Recombinant Human Luteinizing Hormone (Lutropin Alfa) Supplementation in Ovarian Stimulation for Assisted Reproduction?

Nawroth

Ludwig

2006

Womens Health (Lond Engl)

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Luteinizing hormone is now available as the recombinant product, lutropin alfa for the treatment of female infertility. It is necessary in the natural process of follicular growth and maturation. It is not yet clear which patients really benefit from the addition of this medication to conventional gonadotropin stimulation procedures in infertility treatment. Certainly, it has a proven benefit in patients suffering from hypogonadotropic hypogonadism (WHO I). Others may be older patients, patients with a profound gonadotropin suppression stimulated in long gonadotropin-releasing hormone agonist protocols, or patients with poor ovarian response to conventional stimulation strategies. The available data are reviewed herein.

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Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF

Abstract: Profound suppression of LH on day 8 of stimulation is associated with a significantly higher chance of achieving an ongoing pregnancy. More studies are necessary to evaluate this phenomenon further.

Cited by 94 publications

References 34 publications

The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome

The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome

Ultrasound in Follicle Monitoring for Ovulation Induction/IUI

Is there a Need for Recombinant Human Luteinizing Hormone (Lutropin Alfa) Supplementation in Ovarian Stimulation for Assisted Reproduction?

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