Xu Zijin, Lin Qiwang, Liang Zhu, Li Sichen, Wu Yixuan, Fu Yang, Liu Jianqiao, Liu Haiying
Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Guangdong Provincial Key Laboratory of Major Obstetric Diseases, Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology, Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine, The Third Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
BJOG. 2025 Apr;132 Suppl 2:44-52. doi: 10.1111/1471-0528.18064. Epub 2025 Jan 8.
To determine the optimal luteinising hormone (LH) level on the trigger day and its impact on pregnancy outcomes in gonadotropin-releasing hormone (GnRH) antagonist protocols using a data-driven approach.
Retrospective cohort study.
Third Affiliated Hospital of Guangzhou Medical University.
Overall, 6107 in vitro fertilisation/intra-cytoplasmic sperm injection fresh embryo transfer cycles with GnRH-antagonist protocols were performed between January 1, 2018 and February 1, 2023.
Restricted cubic spline analysis and segmented regression identified the optimal LH threshold. Patients were categorised into low (≤ 1.6 IU/L) and high (> 1.6 IU/L) LH groups. Propensity score matching (PSM) and multivariable logistic regression were applied to adjust for confounding factors.
Live birth rate per embryo transfer cycle.
The high LH group showed significantly higher live birth rates (42.9% vs. 36.9%, adjusted odds ratio [aOR]: 1.468; 95% CI: 1.220-1.766, p < 0.001), ongoing pregnancy rates (51.4% vs. 43.6%, aOR: 1.498; 95% CI: 1.338-1.678, p < 0.001), clinical pregnancy rates (52.4% vs. 45.6%, aOR: 1.439; 95% CI: 1.285-1.611, p < 0.001) and biochemical pregnancy rates compared with the low LH group, despite retrieving fewer oocytes (median 10 vs. 12, p < 0.001). These results remained consistent after PSM and multivariable logistic regression analysis.
Higher LH levels on the trigger day are associated with improved pregnancy outcomes in GnRH-antagonist protocols. Maintaining an optimal LH range is crucial for balancing oocyte yield and assisted reproductive technology success, highlighting the importance of individualised ovarian stimulation protocols.
采用数据驱动方法确定促性腺激素释放激素（GnRH）拮抗剂方案中扳机日的最佳促黄体生成素（LH）水平及其对妊娠结局的影响。
回顾性队列研究。
广州医科大学附属第三医院。
2018年1月1日至2023年2月1日期间，共进行了6107个采用GnRH拮抗剂方案的体外受精/卵胞浆内单精子注射新鲜胚胎移植周期。
采用受限立方样条分析和分段回归确定最佳LH阈值。将患者分为LH水平低（≤1.6 IU/L）和高（>1.6 IU/L）两组。应用倾向得分匹配（PSM）和多变量逻辑回归调整混杂因素。
每个胚胎移植周期的活产率。
与低LH组相比，高LH组的活产率显著更高（42.9%对36.9%，调整后的优势比[aOR]：1.468；95%可信区间[CI]：1.220-1.766，p<0.001）、持续妊娠率（51.4%对43.6%，aOR：1.498；95%CI：1.338-1.678，p<0.001）、临床妊娠率（52.4%对45.6%，aOR：1.439；95%CI：1.285-1.611，p<0.001）和生化妊娠率，尽管获取的卵母细胞较少（中位数分别为10个和12个，p<0.001）。在PSM和多变量逻辑回归分析后，这些结果仍然一致。
在GnRH拮抗剂方案中，扳机日较高的LH水平与改善妊娠结局相关。维持最佳LH范围对于平衡卵母细胞产量和辅助生殖技术成功率至关重要，凸显了个体化卵巢刺激方案的重要性。
