Effects of increasing serum luteinizing hormone levels during early phase of the gonadotropin-releasing hormone antagonist protocol on clinical outcomes of the in vitro fertilization cycle

Abstract

Objective

To determine the effects of changes in serum luteinizing hormone (LH) levels in the early stages of the gonadotropin-releasing hormone antagonist (GnRH-A) protocol on in vitro fertilization and embryo transfer/intracytoplasmic sperm injection clinical outcomes.

Methods

Data from 2116 fresh embryo transfer cycles with the GnRH-A protocol were retrospectively analyzed. Patients were divided into two groups, ΔLH-increased and ΔLH-decreased, according to changes in serum LH levels on the day of GnRH-A addition compared with that on the start day of ovarian stimulation. Patients in whom ΔLH increased were categorized according to early-onset LH increases (serum LH level ≥10 mIU/mL or twice the baseline).

Results

ΔLH increased and decreased in 14.9% and 85.1% of patients, respectively. The fertilization rate was lower, and fewer oocytes were retrieved in patients with increased ΔLH compared to those with decreased ΔLH (p < .05). The number of AFC, oocytes retrieved, and AMH in patients with early-onset ΔLH increase was lower between the subgroups (p < .05). There were no significant differences in clinical pregnancy, early abortion, biochemical pregnancy, and live birth rates between the groups and subgroups (p > .05).

Conclusions

Early increases in LH levels during GnRH-A protocol might affect the number of oocytes retrieved, but not the clinical outcomes.

促性腺激素释放激素拮抗剂方案早期增加血清促黄体生成素水平对体外受精周期临床结局的影响 摘要

目的：探讨促性腺激素释放激素拮抗剂（GnRH-A）方案早期血清黄体生成素(LH)水平的变化对体外受精和胚胎移植/胞浆内精子注射临床结局的影响。

方法：回顾性分析采用GnRH-A方案的2116个新鲜胚胎移植周期的数据。比较加入GnRH-A当日血清LH水平与刺激卵巢开始日的变化, 将患者分为DLH升高和DLH降低两组。DLH升高组的患者根据早发性LH增加进行分类(血清LH水平10mIU/mL或基线的两倍)。

结果：DLH的升高和下降率分别为14.9%和85.1%。与DLH降低组的患者相比, DLH升高组的患者受精率较低, 获得卵母细胞更少(p＜iayu.05)。早发型DLH增加的患者AFC、卵母细胞和AMH数量在亚组间较低(p＜.05)。两组及亚组间临床妊娠、早期流产、生化妊娠及活产率差异无统计学意义(p>.05)。

结论：GnRH-A方案中, 早期LH水平的升高可能影响获得的卵母细胞数量, 但不影响临床结局。

Keywords:

• Gonadotropin-releasing hormone antagonist protocol
• in vitro fertilization-embryo transfer
• intracytoplasmic sperm injection
• luteinizing hormone
• clinical outcome

Acknowledgments

We thank Editage (www.editage.cn) for English language editing.

Disclosure statement

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