No association between endogenous LH and pregnancy in a GnRH antagonist protocol: part II, recombinant FSH

Abstract

The association between endogenous LH concentrations during ovarian stimulation in a gonadotrophin-releasing hormone (GnRH) antagonist protocol and pregnancy likelihood was examined in a large combined analysis of individualized patient data obtained after treatment with recombinant FSH and a GnRH antagonist prior to IVF/intracytoplasmic sperm injection. Data from 1764 patients from six randomized controlled trials were pooled for retrospective analysis. Ongoing pregnancy and miscarriage rates for patients stratified by LH percentiles were assessed. Patients in the lowest LH quartile (<P25) were younger with a higher predicted ovarian reserve and response compared with patients in the highest quartile (>P75). With adjustment for identified predictive factors of pregnancy, estimated odds ratios (95% confidence interval) for ongoing pregnancy for LH categories <P25 versus ⩾P25, >P75 versus ⩽P75 and <P25 versus >P75 were 0.96 (0.75–1.22), 1.13 (0.88–1.45) and 0.89 (0.66–1.21) on stimulation day 8, and 0.96 (0.76–1.21), 1.03 (0.82–1.30) and 0.95 (0.72–1.26) on the day of human chorionic gonadotrophin, respectively. No significant differences in pregnancy or miscarriage rates between the LH categories were observed. Endogenous LH concentrations have no association with the likelihood of ongoing pregnancy in women undergoing ovarian stimulation using a recombinant FSH/GnRH antagonist protocol. Circulating concentrations of LH are suppressed during ovarian stimulation for IVF/intracytoplasmic sperm injection with either gonadotrophin-releasing hormone (GnRH) agonists or antagonists to prevent premature LH rises. The association between circulating LH concentrations during ovarian stimulation and the likelihood of pregnancy was examined in a large combined analysis of individualized patient data obtained after treatment with recombinant FSH to stimulate multifollicular development and a GnRH antagonist (ganirelix) to prevent LH surges. Data from 1764 patients from six randomized controlled trials were pooled for retrospective analysis. Patients were divided into three groups based on their circulating LH concentrations being either low, normal or high on stimulation day 8 and on the day of human chorionic gonadotrophin (HCG) administration, and their ongoing pregnancy and miscarriage rates were calculated. Patients with low LH concentrations were in general younger, had a higher ovarian reserve and more retrieved eggs than patients with high LH concentrations. With adjustment for factors known to affect pregnancy, the chance of ongoing pregnancy was not lower for patients with low or high LH concentrations on stimulation day 8 or day of HCG administration. No significant differences in miscarriage rates between the LH categories were observed either. This combined analysis confirms that the concentrations of circulating LH during GnRH antagonist treatment do not affect the likelihood of ongoing pregnancy in women undergoing ovarian stimulation with recombinant FSH.