Does elevated luteinizing hormone level before trigger mean premature luteinizing hormone surge in advanced-aged women undergoing mild ovarian stimulation?

Abstract

Objective

To explore whether elevated luteinizing hormone (LH) level before trigger means premature LH surge in advanced aged women undergoing mild ovarian stimulation.

Methods

To retrospectively analyze 235 in vitro fertilization/intracytoplasmic sperm injection cycles in women >35 years old with the poor ovarian response (POR) from January 2012 to March 2016. Cycles are named Group 1, Group 2, and Group 3, being treated with gonadotropin-releasing hormone antagonist protocol (76 cycles), mild stimulation protocol using clomiphene citrate (73 cycles), and tamoxifen (86 cycles), respectively.

Main outcome measure(s)

The dynamic change of LH level during stimulation; the proportion of an elevated LH level defined as >10 IU/L on trigger day; the proportion of premature ovulation in each group.

Results

Serum LH level increased early in Group 2 and Group 3 and remained significantly higher than that in Group 1 during stimulation. In a sequence of three groups, the proportion of elevated LH levels before the trigger was 11.84, 43.8, and 37.21% (p＜.001) respectively. And the proportion of premature ovulation in patients with elevated LH levels was 11.11, 18.75, and 25% (p = .11) respectively.

Conclusion

Elevated LH level before trigger does not mean premature LH surge in women more than 35 years old with POR undergoing mild ovarian stimulation with clomiphene or tamoxifen.

扳机前黄体生成素水平升高是否代表卵巢微刺激高龄女性的早发黄体生成素峰 摘要

目标：探讨扳机前黄体生成素( LH )水平升高是否代表卵巢微刺激的高龄女性早发LH峰。

方法：回顾性分析2012年1月至2016年3月的年龄35岁以上的卵巢低反应 （POR）女性的235个体外受精/胞浆内精子注射周期。组1、组2和组3, 分别采用促性腺激素释放激素拮抗剂方案（76个周期）、枸橼酸氯米芬微刺激方案（73个周期）和他莫昔芬治疗方案（86个周期）。

主要结局测量（s）：刺激过程中LH水平的动态变化；扳机日LH水平升高的比例（定义为> 10 IU / L）；各组提前排卵比例。

结果：血清LH水平在组2、组3提前升高, 刺激期间仍明显高于组1。组1、组2、组3中, 扳机前LH水平升高比例依次为11.84, 43.8及37.21%（p＜.001）。LH水平升高的患者发生早发排卵的比例分别为11.11、18.75、25 % ( p =. 11 )。

结论：扳机前LH水平升高并不代表35岁以上POR接受克罗米芬或他莫昔芬卵巢微刺激女性的早发LH峰。

Keywords:

• Elevated LH level on the day of HCG injection
• premature LH surge
• premature ovulation
• oocyte escape
• mild ovarian stimulation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the 5010 grants of Sun Yat-Sen University [No. SYSU2014005], the National Key Research and Development Program of China [2017YFC1001004], and the grants of Secondary Development Projects of Traditional Chinese Herbal Formula Compound [No. YZB20174002].