The effect of a transient premature luteinizing hormone surge without elevated serum progesterone on in vitro fertilization outcomes in a gonadotropin-releasing hormone antagonist flexible protocol

Abstract

During controlled ovarian stimulation, the LH rising before triggering can lead to follicular luteinizations. However, LH can be suppressed immediately and no progesterone elevation with GnRH antagonist. This study retrospectively compared fresh IVF/ICSI cycle outcomes in antagonist protocols between the group with and the group without a premature LH surge. Logistic regression models were fitted to reduce the relevant confounders. Compared between premature LH surge group and control group, the implantation rates were 12.9% (30/233) vs 25.0% (141/536), p = .000; clinical pregnancy rates were 21.0% (25/119) vs 41.6% (119/286), p = .000; live birth rates were17.6% (21/119) vs 29.7% (85/286), p = .012. After adjusting for age, BMI, bFSH, and infertility factors, the adverse effects were still as pronounced for the clinical pregnancy rate (OR = 0.39, 95% CI = 0.24–0.66) and live birth rates (OR = 0.54, 95% CI = 0.32–0.93. In a GnRH antagonist flexible protocol, a transient premature LH surge which can be suppressed immediately after the initiation of antagonist without elevated serum progesterone, will cause a detrimental effect on the development of the embryo and IVF/ICSI pregnancy outcomes in fresh embryo transfer cycles.

摘要

在控制性超促排卵过程中, LH在诱发排卵前升高会导致卵泡黄体化。然而, LH能够立即被抑制, GnRH拮抗剂不使孕酮升高。本研究回顾性比较了有早发LH峰组和无早发LH峰组之间在拮抗剂方案中的新鲜IVF/ICSI周期的结局。采用Logistic回归模型, 减少相关混杂因素。早发LH峰组与对照组相比, 种植率分别为12.9%（30/233）和25%（141/536）, p=.000；临床妊娠率为21.0%（25/119）和41.6%（119/286）, p=.000；活产率为17.6%（21/119）和29.7%（85/286）, p=.012。在对年龄、BMI,、bFSH和不孕因素进行调整后, 临床妊娠率（OR=0.39, 95% CI=0.24-0.66)和活产率（OR=0.54, 95%CI=0.32-0.93）的不良影响仍然显著。在GnRH拮抗剂柔性方案中, 拮抗剂启动后可立即抑制短暂的过早LH峰, 但在血清孕酮不升高情况下, 将对胚胎的发育和新鲜胚胎移植周期的IVF/ICSI妊娠结局产生不利影响。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Ovarian stimulation
• gonadotropin-releasing hormone antagonist
• premature luteinizing hormone surge
• elevated serum progesterone

Author contributions

ZDD analyzed the data and drafted the manuscript. ZD designed the study and revised the manuscript. ZDD and ZD did a major and equal contribution to this work. SZY was responsible for the data acquisition. DCY analyzed and interpreted the data. YQ edited the manuscript. ZJR: gave the final approval of the version to be submitted and is responsible for the whole work. All authors read and approved the final manuscript.

Disclosure statement

All authors declare that they have nothing to disclose.