Department of Obstetrics and Gynecology, Peking University First Hospital, 100034, Beijing, China.
J Ovarian Res. 2023 Jun 27;16(1):119. doi: 10.1186/s13048-023-01219-w.
A premature luteinizing hormone (LH) surge refers to an endogenous LH peak that occurs before follicle maturation or human chorionic gonadotropin injection in the process of controlled ovarian hyperstimulation. The effect of premature LH surge on pregnancy outcomes in fresh embryo transfer cycles is still controversial. The aim of this study was to explore the effect of a premature LH surge without elevated progesterone levels on the cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) of patients during a flexible GnRH antagonist protocol.
A total of 730 infertile women undergoing IVF/ICSI were recruited for this retrospective study. Only women who either delivered a live infant or had no remaining frozen embryos after a single stimulation cycle were included in the analysis. During the study period, each patient underwent a flexible GnRH antagonist protocol. Women were divided into two groups according to the presence or absence of a premature LH surge. The primary outcome measures were the CPR and CLBR per ovarian stimulation cycle. The secondary outcome measures were the number of oocytes retrieved, fertilization rate, good-quality embryo rate, and clinical pregnancy rate.
Ninety-one women (12.47%) experienced a premature LH surge without elevated progesterone levels, and the other 639 (87.53%) women were assigned to the control group. The numbers of oocytes retrieved and fertilization rate were significantly greater in the premature LH surge group than in the control group. There was no significant difference between groups in the good-quality embryo rate, clinical pregnancy rate or live birth rate in the fresh embryo transfer cycle. The primary outcome measures, the CPR and CLBR per ovarian stimulation cycle, were not significantly different between the premature LH surge group and the control group. According to the analysis stratified by ovarian response (normal or high), there were no significant differences in pregnancy outcomes between the groups with and without a premature LH surge.
The retrospective study demonstrated that the patients experiencing a transient premature LH surge without progesterone elevation had equivalent pregnancy outcomes with those without a premature LH surge on a flexible GnRH antagonist protocol. The present conclusions need to be further validated in a prospective well-designed large-scale study.
黄体生成激素（LH）早发是指在控制性卵巢超刺激过程中，卵泡成熟或人绒毛膜促性腺激素注射前出现的内源性 LH 峰。LH 早发对新鲜胚胎移植周期妊娠结局的影响仍存在争议。本研究旨在探讨在灵活 GnRH 拮抗剂方案中，孕酮水平未升高的 LH 早发对患者累积妊娠率（CPR）和累积活产率（CLBR）的影响。
本回顾性研究共纳入 730 名接受 IVF/ICSI 的不孕妇女。仅纳入在单个刺激周期后分娩活婴或无剩余冷冻胚胎的妇女进行分析。在研究期间，每位患者均接受灵活 GnRH 拮抗剂方案。根据是否存在 LH 早发，将患者分为两组。主要结局指标为每个卵巢刺激周期的 CPR 和 CLBR。次要结局指标为获卵数、受精率、优质胚胎率和临床妊娠率。
91 名（12.47%）妇女出现孕酮水平未升高的 LH 早发，其余 639 名（87.53%）妇女被分配至对照组。LH 早发组的获卵数和受精率明显高于对照组。两组新鲜胚胎移植周期的优质胚胎率、临床妊娠率或活产率无显著差异。卵巢反应（正常或高）分层分析显示，LH 早发组与对照组之间的妊娠结局无显著差异。
本回顾性研究表明，在灵活 GnRH 拮抗剂方案中，经历短暂 LH 早发且孕酮水平未升高的患者与无 LH 早发的患者具有相当的妊娠结局。本研究结论需要在前瞻性、精心设计的大规模研究中进一步验证。
