Ince Onur, Yilmaz Bulent
Department of Obstetrics and Gynecology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
Department of Statistics, Middle East Technical University, Faculty of Arts and Science, Ankara, Turkey.
J Obstet Gynaecol Res. 2025 Jan;51(1):e16181. doi: 10.1111/jog.16181.
This study aims to assess the impacts of various trigger day progesterone (P) and luteinizing hormone (LH) levels on live birth rates (LBRs) in fresh in vitro fertilization (IVF) cycles, considering their elevation from stimulation and premature luteinization.
This retrospective cohort study included the first ovarian stimulation cycles with GnRH antagonist protocol of 1253 patients who underwent intracytoplasmic sperm injection and fresh embryo transfer at a tertiary clinic's IVF center between 2010 and 2016. Participants were divided into four groups based on trigger day serum P and LH levels, using the 90th percentile thresholds for P (1.7 ng/mL) and LH (5.2 IU/L). The primary outcome measure was LBR.
The LBRs observed in the respective groups were as follows: P < 1.7 ng/mL and LH <5.2 IU/L (21.3%, 214/1005); P < 1.7 ng/mL and LH ≥5.2 IU/L (19.1%, 22/115); P ≥ 1.7 ng/mL and LH <5.2 IU/L (19.3%, 23/119); and P ≥ 1.7 ng/mL and LH ≥5.2 IU/L (28.6%, 4/14). There were no statistically significant differences between the groups (p = 0.782). Additionally, a multivariate generalized additive model, adjusted for female age, body mass index, infertility duration, number of embryos transferred, and embryo transfer day, found that the interaction between LH and P levels did not significantly predict LBRs (p = 0.533). However, univariate analysis identified an optimal trigger day P range between 0.58 and 1.69 ng/mL for achieving higher LBRs, demonstrating a non-linear relationship. Furthermore, total FSH and LH dosages during stimulation had a statistically significant combined effect on trigger day P levels (p = <0.001), with the addition of LH leading to lower P levels compared to cycles stimulated with recombinant FSH alone.
The relationship and interaction between trigger day LH and P levels do not significantly influence LBRs, as variations in LH do not alter the effect of P, suggesting that the impact of P elevation on LBRs is independent of its cause, whether from ovarian stimulation or premature luteinization.
本研究旨在评估不同触发日孕激素（P）和促黄体生成素（LH）水平对新鲜体外受精（IVF）周期活产率（LBR）的影响，同时考虑到它们因刺激和过早黄体化而升高的情况。
这项回顾性队列研究纳入了2010年至2016年间在一家三级诊所的IVF中心接受卵胞浆内单精子注射和新鲜胚胎移植的1253例患者的首次卵巢刺激周期，采用GnRH拮抗剂方案。根据触发日血清P和LH水平将参与者分为四组，使用P（1.7 ng/mL）和LH（5.2 IU/L）的第90百分位数阈值。主要结局指标是LBR。
各组观察到的LBR如下：P < 1.7 ng/mL且LH < 5.2 IU/L（21.3%，214/1005）；P < 1.7 ng/mL且LH≥5.2 IU/L（19.1%，22/115）；P≥1.7 ng/mL且LH < 5.2 IU/L（19.3%，23/119）；P≥1.7 ng/mL且LH≥5.2 IU/L（28.6%，4/14）。各组之间无统计学显著差异（p = 0.782）。此外，在对女性年龄、体重指数、不孕持续时间、移植胚胎数量和胚胎移植日进行调整的多变量广义相加模型中，发现LH和P水平之间的相互作用并未显著预测LBR（p = 0.533）。然而，单变量分析确定了触发日P的最佳范围在0.58至1.69 ng/mL之间，以实现更高的LBR，显示出非线性关系。此外，刺激期间的总促卵泡激素（FSH）和LH剂量对触发日P水平有统计学显著的联合效应（p = <0.001），与单独使用重组FSH刺激的周期相比，添加LH会导致P水平降低。
触发日LH和P水平之间的关系及相互作用对LBR没有显著影响，因为LH的变化不会改变P的作用，这表明P升高对LBR的影响与其原因无关，无论是来自卵巢刺激还是过早黄体化。
