Abstract
BackgroundWe sought to evaluate the incidence and clinical impact of luteinizing hormone (LH) rises prior to and during gonadotropin-releasing hormone (GnRH) antagonist treatment started on day 5 or 6 of ovarian stimulation with recombinant follicle-stimulating hormone (rFSH).MethodsPooled data from three trials with the GnRH antagonist ganirelix started on day 5 (n = 961) and from five trials with ganirelix started on day 6 (n = 1135) of ovarian stimulation with rFSH were retrospectively analyzed.ResultsThe incidence of LH rises (LH ≥ 10.0 IU/L) prior to ganirelix treatment was 2.3% and 6.6% on ganirelix start days 5 and 6, respectively (P < 0.01). During ganirelix treatment this incidence was 1.2% and 2.3%, respectively (P = 0.06). Women with LH rise on day 5 or 6 had a higher ovarian response with more oocytes recovered, mean ± SD, 12.9 ± 8.5 versus no LH rise, 10.2 ± 6.4 (P < 0.01). In women with and without LH rise prior to ganirelix treatment the ongoing pregnancy rates were similar (26.0% vs 29.9%; odds ratio [OR], 0.89; 95% confidence interval [CI], 0.55-1.44). Women with LH rise during ganirelix treatment had a lower ovarian response with 7.5 ± 6.7 oocytes recovered versus no LH rise, 10.2 ± 6.4 (P = 0.02) and a tendancy for a lower chance of ongoing pregnancy (16.7% vs 29.9%; OR, 0.52; 95% CI, 0.21-1.26).ConclusionsThe incidence of early and late LH rises was low but may be further reduced by initiating ganirelix on stimulation day 5 rather than on day 6. In contrast to women with an early LH rise, women with a late LH rise may have a reduced chance of ongoing pregnancy.
Highlights
We sought to evaluate the incidence and clinical impact of luteinizing hormone (LH) rises prior to and during gonadotropin-releasing hormone (GnRH) antagonist treatment started on day 5 or 6 of ovarian stimulation with recombinant follicle-stimulating hormone
In the early follicular phase of the natural cycle, high follicle-stimulating hormone (FSH) concentrations initiate follicular development, which leads to rising serum estradiol concentrations
Use of a gonadotropin-releasing hormone (GnRH) agonist [4] or antagonist [5] has been shown to improve the reproductive outcome of ovarian stimulation by preventing premature LH surges
Summary
We sought to evaluate the incidence and clinical impact of luteinizing hormone (LH) rises prior to and during gonadotropin-releasing hormone (GnRH) antagonist treatment started on day 5 or 6 of ovarian stimulation with recombinant follicle-stimulating hormone (rFSH). Once serum estradiol concentrations surpass a certain level, a positive feedback loop stimulates the pituitary and results in the preovulatory luteinizing hormone (LH) surge. This LH surge is During induced multiple follicular development, when FSH concentrations are maintained because of exogenous gonadotropin administration, natural selection of a single dominant follicle does not occur and multiple follicles continue to grow. This increased number of follicles produces higher serum estradiol concentrations and the serum estradiol concentration that triggers the preovulatory LH surge is reached prematurely, i.e., before the follicles have fully developed. Use of a gonadotropin-releasing hormone (GnRH) agonist [4] or antagonist [5] has been shown to improve the reproductive outcome of ovarian stimulation by preventing premature LH surges
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