Impact of Luteinizing Hormone on IVF/ICSI Assisted Reproduction on the Initiation Day of Gonadotropin-releasing Hormone Antagonist Protocol.

OBJECTIVE

The aim of the study was to explore the optimal timing of gonadotropin initiation and the reasonable interval of luteinizing hormone (LH) level in the gonadotropin-releasing hormone antagonist (GnRH-A) protocol.

METHODS

A retrospective cohort study was conducted to analyze the LH level in patients with different ovarian response treated in GnRH-A protocol in 1361 IVF/ICSI cycles. Ovarian response (including AMH, AFC) in these patients were divided into the poor ovarian response group (an antral follicle count (AFC) ≤ 6, n = 394), the normal ovarian response group (an AFC > 6 and < 15, n = 570), and the high ovarian response group (an AFC ≥ 15, n = 397), according to the AFC. The patients were sub-grouped according to LH levels on the protocol initiation day, and the clinical outcomes (including dose of Gn initiation, Gn administration days, GnRH-ant administration days, P levels on the HCG day, E2 levels on the HCG day, LH levels on the HCG day, number of embryos transferred, total fertilization rate, embryo implantation rate (%), proportion of 2PN, proportion of good-quality embryos, endometrial thickness on the hCG injection day (mm), moderate to severe OHSS, AFC on the initiation day, proportion of type A endometrium on the hCG injection day, clinical pregnancy rate, biochemical pregnancy rate, early abortion rate, ectopic pregnancy rate) were compared.

RESULTS

On the GnRH-A protocol initiation day, among all patients with different ovarian responses, the body mass index (BMI) in those with an LH ≥ 5 IU/L was lower. The difference of pregnancy outcome between the LH < 5 IU/L group and the LH ≥ 5 IU/L group were not statistically significant among the different ovarian response groups, but the LH < 5 IU/L group had a higher proportion of good-quality embryos (80.3 ± 24.9 vs. 74.8 ± 26.9, P =0.035) than the LH≥5IU/Lgroup in those with poor ovarian response. The total fertilization rate (82.2 ± 18.1 vs 85.4 ± 15.1, P =0.021) and proportion of two pronuclei (2PN) (69.0 ± 20.9 vs 72.7 ± 19.9, P =0.035) were higher in the LH ≥ 5 IU/L group than the LH<5 IU/L group for those with normal ovarian response. The embryo implantation rate (41.4 ± 41.3 vs 52.6 ± 43.4, P =0.012) was higher in the LH ≥ 5 IU/L group than in the LH<5 IU/L group in those with high ovarian response. The results of the multivariate logistic analysis showed that the age of the female partner, number of embryos transferred, proportion of good-quality embryos, endometrial thickness on the hCG injection day, and moderate-to-severe ovarian hyperstimulation syndrome (OHSS) were independent factors correlated with the outcome of live births (P < 0.05).

CONCLUSION

The LH levels on the gonadotropins (Gn) initiation day in GnRH-A protocol will not affect pregnancy outcomes.