The LH endocrine profile in gonadotropin-releasing hormone analogue cycles

Abstract

Research question: What does the evolution of serum luteinizing hormone (LH) levels look like throughout the follicular phase of cycles in which gonadotrophins and gonadotropin-releasing hormone (GnRH) analogues in the context of ovarian stimulation for assisted reproduction technologies (ART) were used?

Design: This was a retrospective, observational cohort study in a tertiary infertility clinic. 1303 patients aged between 18 and 43 years of age were included with a total of 2200 cycles for ART, using GnRH-analogues for pituitary down-regulation stimulated with human menopausal gonadotropin (hMG) or recombinant follicle stimulating hormone (rec-FSH). Follicular evolution of LH during ovarian stimulation in different treatment protocols was modeled as repeated measures.

Results: LH evolution showed a significant decrease in antagonist/hMG cycles of 0.17 IU/L per day (95% CI [-0.20, −0.12]) and 0.26 IU/L per day in rec-FSH cycles (95% CI [-0.29, −0.22]). This decrease was significantly stronger in rec-FSH cycles than in hMG cycles (estimated difference of 0.09 IU/L per day, 95% CI [0.04, 0.15]). Short agonist/hMG cycles showed a significant increase in LH of 0.04 IU/L per day (95% CI [0.01, 0.08]), while the increase of 0.01 IU/L per day in cycles with rec-FSH was not significant (95% CI [-0.08, 0.10]).

Conclusion: Follicular evolution of LH during controlled ovarian stimulation differs between different GnRH analogue cycles. A statistically significant decrease in LH was shown in GnRH antagonist cycles being more pronounced with rec-FSH compared to hMG. This decrease in LH in antagonist cycles and the potential impact on estradiol levels and follicle growth needs further examination.

摘要

研究问题

在辅助生殖技术（ART）的卵巢刺激中应用促性腺激素和促性腺激素释放激素（GnRH）类似物的整个卵泡期, 血清黄体生成素（LH）水平的变化是什么样的？

设计

这是一项在三级不孕症诊所进行的回顾性观察性队列研究。纳入1303例年龄在18至43岁之间的患者, 共2200个ART周期, 应用GnRH类似物进行垂体降调, 用人绝经促性腺激素(hMG)或重组卵泡刺激素(rec-Fsh)进行刺激。在不同治疗方案中, 卵巢刺激期间LH水平的卵泡期变化被模拟为重复测量。

结果

拮抗剂/hMG周期LH显著降低, 每天下降0.17 IU/L（95%CI【-0.20, 0.12】）, 在rec-Fsh周期中每天下降0.26 IU/L（95%CI【-0.29, 0.22】）。在rec-Fsh周期中LH的下降显著大于hMG周期（估计差异为0.09 IU/L/天, 95%CI【0.04, 0.15】）。短激动剂/hMG周期LH显著增加, 0.04 IU/L/天(95%CI[0.01,0.08])；而rec-Fsh周期中LH增加不显著(95%CI[-0.08,0.10]) , 为0.01 IU/L/天。

结论

在不同的GnRH类似物周期中, 控制性卵巢刺激期间LH的卵泡期变化是不同的。与hMG相比, rec-Fsh在GnRH拮抗剂周期中LH的降低更明显。拮抗剂周期中LH的降低及其对雌二醇水平和卵泡生长的潜在影响需要进一步研究。

Keywords:

• luteinizing hormone
• ovarian stimulation
• endocrine profile
• GnRH agonist
• GnRH antagonist

关键词:

• 黄体生成素
• 卵巢刺激
• 内分泌谱
• GnRH激动剂
• GnRH拮抗剂

Acknowledgements

We gratefully acknowledge the contribution of Elyne Scheurwegs of the Department of Informatics, Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Belgium.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by an unrestricted research grant from Merck to the Center for Reproductive Medicine.