Does premature luteinizing hormone (LH) elevation in the absence of elevated progesterone influence outcome in antagonist in vitro fertilization (IVF) cycles?

Abstract

OBJECTIVE: Controversy remains as to whether premature LH surge in the absence of elevated progesterone during gonadotropin releasing hormone (GnRH) antagonist IVF cycles leads to poorer outcomes. The objectives of this study were twofold: 1) To examine patient characteristics that may predispose to premature LH surge, and 2) To determine whether premature elevations in LH (defined as >/= 10 IU/l) not associated with concomitant increases in progesterone affect pregnancy outcome.DESIGN: Retrospective cohort study.MATERIALS AND METHODS: Patients who underwent an IVF cycle using a flexible GnRH antagonist protocol from 1/1/2007 through 3/1/2009 were analyzed. The following data was recorded for comparison: age, day 3 follicle stimulating hormone (FSH), antral follicle count, days of FSH stimulation, day of antagonist start, estradiol (E2) on day of antagonist start, E2 level on day of ovulation trigger, number of follicles > 10 mm at trigger, total FSH dose, highest LH value, progesterone level associated with LH >/=10 IU/l, number of oocytes retrieved, number of two pronucleate (2PN) embryos, number of embryos transferred, and ongoing pregnancy rate. Student's t-test and chi square were used to compare variables between cycles with and without an LH surge.RESULTS: A total of 336 cycles were analyzed, of which 43 had a premature LH surge (12.8% incidence). Of those cycles with premature LH surge, 25 underwent fresh embryo transfer and 18 underwent cryopreservation of all embryos. Patient age and estradiol level at initiation of GnRH antagonist were significantly higher in patients who experienced a premature LH surge. However, the number of oocytes obtained and number of 2PN embryos in the LH surge group were also significantly higher. Ongoing pregnancy rate was not statistically different between the two groups.CONCLUSIONS: Premature LH surge in the absence of an elevated progesterone level does not appear to affect pregnancy outcome. However, analysis of a larger number of cycles is needed to validate this finding. OBJECTIVE: Controversy remains as to whether premature LH surge in the absence of elevated progesterone during gonadotropin releasing hormone (GnRH) antagonist IVF cycles leads to poorer outcomes. The objectives of this study were twofold: 1) To examine patient characteristics that may predispose to premature LH surge, and 2) To determine whether premature elevations in LH (defined as >/= 10 IU/l) not associated with concomitant increases in progesterone affect pregnancy outcome. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients who underwent an IVF cycle using a flexible GnRH antagonist protocol from 1/1/2007 through 3/1/2009 were analyzed. The following data was recorded for comparison: age, day 3 follicle stimulating hormone (FSH), antral follicle count, days of FSH stimulation, day of antagonist start, estradiol (E2) on day of antagonist start, E2 level on day of ovulation trigger, number of follicles > 10 mm at trigger, total FSH dose, highest LH value, progesterone level associated with LH >/=10 IU/l, number of oocytes retrieved, number of two pronucleate (2PN) embryos, number of embryos transferred, and ongoing pregnancy rate. Student's t-test and chi square were used to compare variables between cycles with and without an LH surge. RESULTS: A total of 336 cycles were analyzed, of which 43 had a premature LH surge (12.8% incidence). Of those cycles with premature LH surge, 25 underwent fresh embryo transfer and 18 underwent cryopreservation of all embryos. Patient age and estradiol level at initiation of GnRH antagonist were significantly higher in patients who experienced a premature LH surge. However, the number of oocytes obtained and number of 2PN embryos in the LH surge group were also significantly higher. Ongoing pregnancy rate was not statistically different between the two groups. CONCLUSIONS: Premature LH surge in the absence of an elevated progesterone level does not appear to affect pregnancy outcome. However, analysis of a larger number of cycles is needed to validate this finding.