Lower Luteinizing Hormone Levels Research Articles

Edible bird's nest improves the premature ovarian failure induced by tripterygium glycosides

AbstractPremature ovarian failure (POF) is a common disease in the field of gynecological endocrinology that seriously affects the physical and mental health of patients. Previous studies found that edible bird's nest (EBN) could improve uterine function. These suggested that EBN might also have an ameliorating effect on POF. Therefore, in this study, tripterygium glycosides (TGs) were used to induce POF in rats, and the effect of EBN on the improvement of POF was investigated. After the administration of EBN for 14 days, ovarian index and uterine index, serum hormone levels, apoptosis rate of ovarian granulosa cells, follicle‐stimulating hormone receptor (FSHR) protein expression level, and the histopathological examination of the ovaries were determined. It was found that administration of medium and high EBN dose groups increased the ovarian index and granular layer thickness of rats with POF. Particularly, higher follicle‐stimulating hormone levels and lower corpus luteum content were observed in the high EBN dose group. In addition, there were lower luteinizing hormone levels and fewer atretic follicles but higher progesterone levels in the medium EBN dose group. These results indicated that EBN had preventive and curative effects on POF induced by TGs. Its mechanism of action might be related to the reduction of ovarian granulosa cell apoptosis, regulation of hormones and receptors, and inhibition of follicle closure.

Effect of trigger day serum luteinising hormone levels on the in-vitro fertilization outcome: an observational study.

Controlled ovarian stimulation leads to profound changes in the endocrine characteristics of the ovarian cycle. Serum luteinising hormone (LH) levels on the day of trigger have been shown to correlate with oocyte quality and pregnancy rate in antagonist cycles. This is an observational study of 86 women undergoing an antagonist in-vitro fertilisation cycle. Oocyte maturation trigger used was either Inj. human chorionic gonadotropin or Inj. triptorelin 0.2 mg s/c or a combination of both. Women were categorised into four groups based on serum LH levels on the day of trigger i.e., LH ≤0.5 (n=8), LH=0.6- 1.0 international units (IU)/L (n=12), LH=1.0-1.5 IU/L (n=13), and LH >1.6 IU/L (n=53) and the subgroup analysis was done based on type of trigger used. Mature oocyte (MII) retrieval rate did not show a significant relation with serum LH levels (87%, 89%, 77%, and 76% in groups with LH <0.5, 0.5-1.0, 1.0-1.5, and >1.5 IU/L respectively; P-value=0.243). There was no significant difference in the clinical pregnancy rate either when women were split according to the type of trigger given or according to trigger day LH levels. Women with low LH levels (<0.5 IU/L) required significantly more doses of gonadotropins compared to women with LH levels of 1.0-1.5 IU/L. (3,531+1,133 vs. 2,281+938; P-value=0.01). Based on the observation from the current study, there was no significant association of serum LH levels with MII retrieval rate and clinical pregnancy rate. The group with low LH levels required slightly longer days of stimulation.

A Case-Control Study on Factors Associated With Secondary Amenorrhea Among the Medical Students of Universiti Malaysia Sabah.

This study aimed to evaluate the association between body mass index (BMI), anxiety, stress, depression, hormones, and secondary amenorrhea among female medical students at Universiti Malaysia Sabah (UMS). In this case-control study, UMS undergraduate female medical students aged 19-25 years who did not menstruate in the last three months (with a previous history of a regular menstrual cycle) or six months (with a history of irregular menstruation) were included as cases (40 students), and students with similar criteria but no menstrual irregularities were recruited in the study as controls (40 students). The study was conducted at Polyclinic UMS from January 1, 2021, until December31, 2022. The chi-squared test and odd ratio examined the association of the above-mentioned factors with the secondary amenorrhea. A p-value less than 0.05 was considered significant, and an odds ratio if the confidence interval did not contain one was considered significant. Both the groups had a similar frequency of different BMI grades. The cases exhibited significantly higher levels of depression, anxiety, and stress than the controls. Again, the cases demonstrated higher estradiol (E2), testosterone, and thyroid-stimulating hormone (TSH) levels and lower levels of luteinizing hormone (LH) than those with regular menstruation. The research also revealed that a one-unit decrease in follicle-stimulating hormone (FSH) levels corresponds to a threefold increase in the risk of experiencing secondary amenorrhea, while the risk escalates to fourfold for LH.Moreover, E2, testosterone, and TSH levels exhibited protective effects on secondary amenorrhea. Anxiety, serum LH, and FSH were significantly associated with secondary amenorrhea. Future studies should address the diurnal variation of the hormones and consider the participants' circumstances to get a proper effect of hormonal influence and stress.

Dissecting the efficacy of the use of acupuncture and Chinese herbal medicine for the treatment of premature ovarian insufficiency (POI): A systematic review and metaanalysis

Premature ovarian insufficiency is a multi-factor gynecological disease that has become a major global health problem. In recent years, several trials have explored the treatment of premature ovarian insufficiency using Chinese herbal medicine and acupuncture, but the efficacy and safety of this combination remains controversial. This systematic review and meta-analysis aimed to comprehensively evaluate the efficacy and safety of combining Chinese herbal medicine with acupuncture to treat premature ovarian insufficiency. From eight different databases, we retrieved randomized controlled trials wherein Chinese herbal medicine and acupuncture had been compared with western medicine in the treatment of premature ovarian insufficiency. The bias risk assessment stipulated by the Cochrane Collaboration's tool was utilized to evaluate the quality of the chosen randomized controlled trials. This meta-analysis was executed with the help of Review Manager 5.3 and Stata 10.0. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A total of 10 randomized controlled trials involving 594 premature ovarian insufficiency patients were included in the analysis. Compared with western medicine, co-treatment with acupuncture and Chinese herbal medicine exhibited a significantly higher total effective rate (relative risk: 1.21; 95% confidence interval: 1.12–1.31; P < 0.01, I2 = 0%), but lower levels of luteinizing hormone (standardized mean difference: −0.57; 95% confidence interval: −1.06, −0.08; P < 0.05, I2 = 80%), follicle-stimulating hormone, and Kupperman index score. Moreover, the combined intervention increased estradiol level in the serum. Overall, the data demonstrate that acupuncture plus Chinese herbal medicine is an efficacious and safe treatment option for POI patients. These findings must be verified by conducting large-scale, multicenter, high-quality, and long-term randomized controlled trials.

LH on GnRH-ant day to basal LH affects the IVF/ICSI outcome of PCOS women undergoing GnRH-antagonist protocol.

The aim of this study was to investigate the influence of ratio of serum luteinizing hormone (LH) on gonadotropin-releasing hormone antagonist (GnRH-ant) day to basal LH (hLH/bLH) on in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) outcome in polycystic ovary syndrome (PCOS) women who received GnRH-ant protocol for controlled ovarian hyperstimulation (COH). This retrospective study was conducted in women with PCOS (n = 1116) who underwent the GnRH-ant protocol for COH between 2015 and 2022 and were stratified as group A (hLH/bLH < 1, n = 489) and group B (hLH/bLH ≥ 1, n = 627) according to the variation of serum LH. The outcomes of COH and the first frozen embryo transfer (FET) cycle were compared between group A, B and the linear relationship between hLH/bLH ratio and IVF/ICSI outcomes were studied by multivariate linear regression analysis and restricted cubic spline (RCS) models. There were significant differences in baseline characteristics and outcomes between group A and B. Group A had higher levels of bLH, AMH, estradiol (E2) on GnRH-ant start day and lower levels of LH on GnRH-ant start day. Group B has better ovulation induction outcomes: more retrieved oocytes, normally fertilized oocytes (2PN), cleavage embryos, available embryos and high-quality blastocysts. Multivariate linear regression analysis found no statistically significant connection between hLH/bLH and clinical outcomes. RCS models showed hLH/bLH had nonlinear association with outcomes, including number of oocytes retrieved, 2PN, available embryos, incidence of OHSS, chemical pregnancy, clinical pregnancy, abortion and live birth. hLH/bLH ratio could be a more forward-looking indicator of clinical outcome in women with PCOS undergoing GnRH-ant protocols than LH on trigger day and the ratio of LH level on trigger day to basal LH. hLH/bLH = 1 may be the best condition for higher live birth rate and lower OHSS rate.

The value of LH maximum level in predicting optimal oocyte yield following GnRH agonist trigger.

Risk factors associated with a suboptimal response to Gonadotropin-releasing hormone (GnRH) agonists include a high or low body mass index (BMI), prolonged use of oral contraceptive pills, and low luteinizing hormone (LH) levels on either the start or trigger days of controlled ovarian stimulation (COS). However, this approach may increase the need for a dual trigger and may also result in a higher incidence of ovarian hyperstimulation syndrome (OHSS) in hyper-responders. We aimed to investigate whether the maximum LH level during stimulation can serve as a predictive factor for achieving an optimal oocyte yield using the GnRH agonist trigger alone. We retrospectively reviewed all antagonist protocols or progestin-primed ovarian stimulation (PPOS) protocols triggered with GnRH agonist only between May 2012 and December 2022. Subjects were divided into three groups, depending on basal LH level and LH maximum level. The freeze-all strategy was implemented in all cycles: Group 1, consistently low LH levels throughout COS; Group 2, low basal LH level with high LH max level during COS; Group 3, consistently high LH levels throughout COS. The primary outcome was the oocyte yield rate. The secondary outcome includes the number of collected oocytes, suboptimal response to GnRH agonist trigger, oocyte maturity rate, fertilized rate, clinical pregnancy rate, ongoing pregnancy rate, and live birth rate. The pregnancy outcomes were calculated for the first FET cycle. Following confounder adjustment, multivariable regression analysis showed that Group 1 (cycles with consistently low LH levels throughout COS) remains an independent predictor of suboptimal response (OR: 6.99; 95% CI 1.035-47.274). Group 1 (b = -12.72; 95% CI -20.9 to -4.55) and BMI (b = -0.25; 95% CI -0.5 to -0.004) were negatively associated with oocyte yield rate. Patients with low basal LH but high LH max levels had similar clinical outcomes compared to those with high LH max levels through COS. The maximum LH level during COS may serve as an indicator of LH reserve and could be a more reliable predictor of achieving an optimal oocyte yield when compared to relying solely on the basal LH level. In the case of hyper-responders where trigger agents (agonist-only or dual trigger) are being considered, we propose a novel strategy that incorporates the maximum LH level, rather than just the basal or trigger-day LH level, as a reference for assessing LH reserve. This approach aims to minimize the risk of obtaining suboptimal oocyte yield and improve overall treatment outcomes.

Metabolic characteristics of obese patients with polycystic ovarian syndrome: a meta-analysis

Objective Though recent studies have pointed out different manifestations between obese and nonobese patients with polycystic ovarian syndrome (PCOS), there is no clear evidence to confirm this viewpoint. Therefore, the metabolic characteristics of obese and nonobese patients with PCOS were systematically compared through meta-analysis in this study. Methods Data were searched from PubMed, Web of Science, Embase, Cochrane Library, CNKI, and Wanfang databases. Articles on obese and nonobese patients with PCOS published from database inception to January 2022 were included. Meta-analysis was performed using Stata 16.0 statistical software. Results A total of 739 articles were initially retrieved, and ultimately 14 studies were involved in the meta-analysis. Specifically, there were 801 patients in the observation group (obese patients with PCOS) and 925 patients in the control group (nonobese patients with PCOS). Compared with the control group, the observation group had significantly lower levels of sex hormone-binding globulin (SHBG), high-density lipoprotein (HDL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and higher levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL). Nevertheless, there were no significant differences between the two groups in systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, and testosterone. Conclusion Compared with nonobese patients with PCOS, obese patients with PCOS have worse blood lipid parameters and lower levels of LH and FSH. Also, there are significant differences in metabolic characteristics between the two groups of patients. Most importantly, our findings provide guidance for the clinical diagnosis and treatment of PCOS.

Abstract #1375340: Correlation of Follicle Stimulating Hormone and Luteinizing Hormone Levels with HbA1c in Post-Menopausal Females

Menopause in female is a normal physiological process however, it is also a well-established risk factor for CVD and osteoporosis. Few studies suggest that low FSH is associated with adiposity and diabetes in post-menopausal women. Aim of this study was to explore correlations of follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels with HbA1c level in post-menopausal females. The study was conducted at of Dr. S.N. Medical College, Jodhpur, India. Otherwise healthy postmenopausal women attending hospital for preventive health checkup were included in study. Postmenopausal status was confirmed by the absence of menses for at least 12 months. Known case of T2D/T1D, subjects on hormone replacement therapy, acutely sick were excluded from study. The baseline fasting blood samples were collected. Samples was assayed for FSH, LH, HbA1c and standard biochemical profile (glucose, lipid profile, Live function tests and renal function tests) using standard methods. The participants were classified as having diabetes or prediabetes using ADA criterias. Total 229 postmenopausal women were enrolled. Mean age of subjects was 63.2±9.9 years. Mean Hba1c was 6.2±1.4 gm% and subjects were further divided in to non-diabetes (68/229), prediabetes (104/229) and diabetes group (57/229) according to Hba1c levels. Mean LH was 25.8±15.6, FSH was 61.1±30.1 and LH/FSH ratio was 0.47±0.35. Mean LH was 31.4±15.8, 26.0±16.3, 19.5±12.6 in non-diabetes, prediabetes and diabetes group respectively. Mean FSH was 75.9±29.3, 59.6±27.6, 46.9±29.0 in non-diabetes, prediabetes and diabetes group respectively. The LH and FSH values in non-diabetes and diabetes group were statistically significant (p<0.01). In this study low FSH and LH levels were associated with higher level of HbA1c and increased risk of T2D.

Effect of leuprorelin plus growth hormone on serum luteinizing hormone, follicle stimulating hormone, and estradiol levels in children with idiopathic central precocious puberty

Purpose: To evaluate the effects of leuprorelin plus growth hormone on serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2) levels in children with idiopathic central precocious puberty. Methods: A total of 102 girls with idiopathic central precocious puberty who met the inclusion criteria between April 2020 and September 2021 were enrolled in this study, and assigned randomly to either a control group given leuprorelin only, or a combined treatment group given leuprorelin plus growth hormone. There were 51 cases in each group. The parameters/indices evaluated include sex hormone levels (serum LH, FSH, and E2), height standard deviation scores (HtSDS), predicted adult height (PAH), and insulin-like growth factors-1 (IGH-1). Results: Patients administered combined therapy showed lower levels of LH, FSH, and E2 than those on mono-therapy (p &lt; 0.05). Leuprorelin plus growth hormone resulted in significantly higher HtSDS and PAH, and lower IGF-1 levels compared with those who received leuprorelin (p &lt; 0.05). Conclusion: The combination of leuprorelin and growth hormone effectively reduces the serum levels of LH, FSH, and E2 in children with idiopathic central precocious puberty, and improves their linear growth rate and adult height. However, economic benefits and patient acceptance should be considered in future studies to assess its overall applicability.

Characteristics and possible mechanisms of metabolic disorder in overweight women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a kind of endocrine and metabolic disorder, disturbing the females of reproductive age. Here, we aimed to investigate the metabolic characteristics of overweight women with PCOS and analyze the possible mechanisms. We conducted a cross-sectional study on 947 patients with PCOS, who were classified according to body mass index (BMI) as overweight (BMI ≥ 24 kg/m2) or non-overweight (BMI ≤ 23.9 kg/m2). The clinical symptoms, endocrine features, metabolic status, and inflammatory levels of the patients were comprehensively assessed and compared between the patients of the two groups. Additionally, a predictive study on the correlation between inflammation and metabolism was performed using STRING and Cytoscape software, and the possible mechanisms of metabolic disorders involved in the overweight PCOS were preliminarily explored. Overweight PCOS was associated with increased average age, waist-to-hip ratio, and the incidence of acanthosis nigricans. These patients were susceptible to familial hypertension and diabetes, and exhibited evident characteristics of low levels of luteinizing hormone (LH) and the ratio of LH to follicle-stimulating hormone, and were more inclined to insulin resistance (IR). Furthermore, overweight PCOS presented with a chronic low-grade inflammation state with increased levels of inflammatory cytokines complement components C5/C5α, CXCL12/SDF-1, MIF, and Serpin E1/PAI-1 evidently compared with those in non-overweight PCOS. Pearson analysis showed that these inflammatory cytokines were directly or indirectly correlated with IR. The STRING and Cytoscape network analysis predicted that inflammatory cytokines CXCL12/SDF-1, Serpin E1/PAI-1 and MIF might be crucial for inducing IR in overweight PCOS women through various biological functions and signal transductions including the JAK-STAT cascade, ATP biosynthesis, and HIF-1 signaling. Overweight patients with PCOS are prone to low gonadal levels, IR, and chronic low-grade inflammation. Inflammatory cytokines CXCL12/SDF-1, Serpin E1/PAI-1and MIF might lead to IR through multiple biological functions and signal transductions in overweight PCOS.

Evaluation of factors predicting pregnancy by comparing successful IVF cycles with previous failed ones of the same patients in the same year

Aim: In this study, we aimed to examine the factors predicting pregnancy by comparing successful in vitro fertilization/ intracytoplasmic sperm injection (IVF)/(ICSI) fresh cycles with previous failed ones of the same patients in the same year. Materials and Methods: The study consisted of two groups, failed (n:283) and successful IVF fresh cycles (n:283) that applied one after another within the same year, thusly each woman acted under her own control. IVF treatment indications, antral follicle count, ovulation induction protocol type, initial and total gonadotropin dose, progesterone, and estradiol (E2) levels on the trigger day, the number of oocytes retrieved and mature oocytes, number of Grade 1, Grade 2, Grade 3 embryo, day of embryo transfer (ET), endometrial thickness on trigger and oocyte pick-up (OPU) day, embryo-fundus distance and beta-human chorionic gonadotropin (B-hCG) levels on the 10th day after the ET were measured. The same luteal phase support was administered in both groups. Results: Totally 566 cycles and 283 women were included in the study. There was a significant difference in luteinizing hormone (LH) levels on OPU day and number of grade 1 ET between the two groups, LH levels on OPU day and number of grade 1 ET were higher in successful IVF fresh cycles group (p&lt;0.05). Conclusion: Low serum LH levels on OPU day was associated with decreased pregnancy results. Increased IVF success was observed in grade 1 ET cycles.

Low LH level does not indicate poor IVF cycle outcomes with GnRh-a single trigger: a retrospective analysis

ObjectiveTo compare the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycle outcomes between patients with low and normal serum luteinizing hormone (LH) levels on the day after a gonadotropin-releasing hormone agonist (GnRH-a) single trigger. We further investigated the efficacy of human chorionic gonadotropin (hCG) retrigger on IVF cycle outcomes in patients with low LH levels after GnRH-a single trigger.MethodsWe retrospectively analyzed 957 infertile patients (tubal factor, ovulation disorders, male sperm factor, or unexplained infertility) who were treated with IVF/ICSI at the Chengdu Xinan Gynecology Hospital from July 2017 to December 2020. Patients received sufficient GnRH-a single trigger were divided into two groups based on the serum LH levels on the next day of trigger: normal serum LH levels (≥ 10 mIU/mL) group (control group, n = 906) and low LH levels (< 10 mIU/mL) group (experimental group, n = 51). And the efficacy of hCG retrigger on IVF/ICSI cycle outcomes in 10 patients with low LH levels after GnRH-a single trigger.ResultsThere were no significant differences in IVF/ICSI cycle outcomes, including egg yield, two pronuclei fertilization rate, excellent embryo rate, or live birth rate of frozen-thawed embryos between patients with low and normal LH levels after GnRH-a trigger. It showed significantly higher risk of ovarian hyperstimulation syndrome in the group of low LH levels [ 0.7%(1/137) vs. 8.5%(4/47), P = 0.016] compared with the group of normal LH levels who received GnRH-a single trigger. The hCG retrigger had no obvious efficacy on cycle outcomes in patients with low LH levels, including oocytes retrieved, fertilization rate, embryo conditions, and live birth rate of frozen-thawed cycles.ConclusionThe IVF/ICSI cycle outcomes of patients with low LH levels on the day after GnRH-a administration were similar to those of patients with normal LH levels. Blood LH test might not be required on the day following the trigger. The hCG retrigger did not have any effect on the cycle outcomes, suggesting that immediate retriggering with hCG was unnecessary.

Effect of follicle-stimulating hormone and luteinizing hormone levels on egg-laying frequency in hens.

Gonadotropins, for example, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), are hormones that affect the reproductive process. In hens, optimal levels of FSH and LH can stimulate follicle growth fairly rapidly and thereby increase egg production through follicle development and increased ovulation. Follicle-stimulating hormone acts in the early stages of follicular growth, whereas LH acts on pre-ovulatory follicles. Normal follicular growth is the result of the complementary action of FSH and LH. Low FSH and LH levels result in the formation of follicles but a lack of egg production in chickens. This study aimed to investigate FSH and LH hormone levels from layer chickens with different egg-laying frequencies. Fifty blood serum samples were collected from 54-week-old ISA brown strain hens that were divided into five groups (with 10 hens per group) as follows: Hens that lay eggs (i) every day, (ii) once every 2 days, (iii) twice every 3 days, (iv) 3 times every 4 days, and (v) hens that do not lay eggs. Follicle-stimulating hormone and LH levels were measured in samples using an enzyme-linked immunosorbent assay, and the data were analyzed using multivariate analysis of variance. Follicle-stimulating hormone levels were significantly associated with the frequency of egg laying in ISA brown strain hens (p < 0.05); the highest FSH level (869.005 ± 149.194 pg/mL) was found in hens that lay eggs every day. In contrast, the highest LH level (51.386 ± 2.410 mIU/mL) was found in hens that lay eggs every 2 days. High level of FSH (869.005 ± 149.194 pg/mL) was associated with a high frequency of egg laying (every day) in ISA brown strain hens, and LH level of around 30.406 pg/mL was associated with daily egg laying in these hens.

A novel compound variant in GNRHR causing congenital idiopathic hypogonadotropic hypogonadism in a young male Korean patient.

Idiopathic hypogonadotropic hypogonadism (IHH) is a disease that shows symptoms of no or incomplete sexual maturation after 18 years old. The mutation of gonadotropin releasing hormone receptor gene (GNRHR) has been reported as the cause in 16% of total IHH patients. An 18-year-old adolescent was referred to endocrinology department for hypogonadism. He was born with cryptorchidism, had small testes at the age of 7 years, and showed low testosterone levels. Management of his hypogonadism was delayed due to his uncontrolled nephrotic syndrome. There were no abnormal findings on the brain MRI; atrophied testes discovered on his pelvis MRI; low levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone were observed. In the HCG simulation test, testosterone levels showed no significant increase, rising from 1.11 to 1.15 ng/dL. The patient harbored a novel compound heterozygous variant of c.514G>A (p.Gly172Arg) and c.113G>A (p.Arg38Gln) in the GNRHR gene. Here, we report a case of new GNRHR compound variant c.514G>A (p.Gly172Arg) and c.113G>A (p.Arg38Gln) in a Korean adolescent for hypogonadotropic hypogonadism.

Low Endogenous LH on the COS Initiation Day of a GnRH-Agonist Regimen Increases the Risk of Early Pregnancy Loss and Adverse ART Outcomes.

ObjectiveTo assess the impact of serum luteinizing hormone (LH) levels on the day of initiation of controlled ovarian stimulation (COS) after pituitary suppression on early pregnancy loss and assisted reproductive technology (ART) outcomes.DesignRetrospective cohort study.SettingUniversity-affiliated hospital.PatientsA total of 9540 normogonadotrophic patients were treated with a GnRH agonist for in vitro fertilization (IVF). Based on the serum concentration of LH on the COS initiation day, patients were divided into low (<1 mIU/mL, n=2838), medium (1–1.49 mIU/mL, n=3357), or high (≥1.5 mIU/mL, n=3345) LH groups and received either fresh embryo transfer (ET) or frozen ET (women with high ovarian response, insufficient endometrial thickness, or requesting frozen ET). A total of 6279 cycles were fresh ET (1960, 2222, and 2097 in the low, medium, and high LH groups, respectively).Intervention(s)During IVF/ICSI, a GnRH agonist was used to suppress pituitary function in the midluteal phase or follicular phase, and then gonadotropin was used to induce COS.Main Outcome Measure(s)The early pregnancy loss rate (ePLR) and live-birth rate (LBR) for fresh ET, as well as the cumulative ePLR and LBR for the entire ovarian stimulation cycle, were compared.ResultsIn the fresh ET cycles, the high, medium and low LH groups had an ePLR of 8.6%, 11.9% and 12.5%, respectively, and LBR of 42.1%, 37.9% and 37.5%, respectively. There were no significant differences in terms of clinical pregnancy rate (CPR), late pregnancy loss rate (lPLR), and ectopic pregnancy rate (EPR) among the three LH groups. For the entire ovarian stimulation cycle, the high LH group had a greater number of retrieved oocytes compared with the low and medium LH groups. Among the groups of high, medium and low LH, the cumulative CPR were 72.8%, 69.8% and 68.8%, respectively, and the cumulative LBR were 63.4%, 60.4% and 58.5%, respectively. There were no significant differences in the cumulative ePLR, lPLR, or EPR. After multivariable logistic regression, compared with the high LH group, the adjusted odds ratio of early pregnancy loss in the low and medium LH group were 1.429 (1.065-1.919, P = 0.018) and 1.389 (1.041-1.853, P = 0.026).ConclusionsAfter pituitary suppression by a GnRH-agonist during IVF, a low LH level (<1.5 mIU/mL) on the COS initiation day was associated with adverse ART outcomes—including fewer oocytes, higher ePLR and lower LBR in fresh ET—and lower cumulative CPR and LBR in the entire ovarian-stimulation cycle. And LH on the COS initiation day was an independent factor affecting ePLR after multivariate regression.

Prediction, assessment, and management of suboptimal GnRH agonist trigger: a systematic review.

This systematic review aimed to identify baseline patient demographic and controlled ovarian stimulation characteristics associated with a suboptimal response to GnRHa triggering, and available options for prevention and management of suboptimal response. PubMed, Google Scholar, Medline, and the Cochrane Library were searched for keywords related to GnRHa triggering, and peer-reviewed articles from January 2000 to September 2021 included. Thirty-seven studies were included in the review. A suboptimal response to GnRHa triggering was more likely following long-term or recent oral contraceptive use and with a low or high body mass index. Low basal serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol serum levels were correlated with suboptimal oocyte yield, as was a low serum LH level on the day of triggering. A prolonged stimulation period and increased gonadotropin requirements were correlated with suboptimal response to triggering. Post-trigger LH < 15 IU/L best correlated with an increased risk for empty follicle syndrome and a lower oocyte retrieval rate. Retriggering with hCG may be considered in patients with suboptimal response according to post-trigger LH, as in cases of failed aspiration. Pre-treatment assessment of patient characteristics, with pre- and post-triggering assessment of clinical and endocrine cycle characteristics, may identify cases at risk for suboptimal response to GnRHa triggering and optimize its utilization.

Annals for Educators - February 2022.

Annals for Educators - February 2022.

The effect of serum luteinizing hormone on trigger day with a GnRH antagonist protocol in IVF/ICSI treatment

ObjectiveTo investigate the effect of serum luteinizing hormone (LH) on trigger day with a Gonadotrophin-releasing hormone (GnRH) antagonist protocol in patients receiving in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment for pregnancy outcomes. MethodsWe retrospectively reviewed the medical documents of patients receiving IVF/ICSI with fresh embryo transfers from the Reproductive Medicine Center of Peking University People's Hospital between January 2016 and December 2018.730 patients were included and divided into three groups by their serum LH level determined on trigger day. All patients were categorized into Group A, Group B, and Group C based on LH concentrations <1.0 IU/L, 1.0–5.0 IU/L, and from 5.0 to 10.0 IU/L on trigger day during the cycle, respectively. Comparisons were made between the three groups. ResultsThere was a significant difference in implantation rates between Group A and Group C (24.8% versus 40.1%, respectively, P ​< ​0.05). The clinical pregnancy rates (39.3% versus 54.3%, respectively, P ​= ​0.078) and live birth rate (LBR) (32.1% versus 46.5%, respectively, P ​= ​0.116), though the differences were not significant. Multivariate logistic regression analysis showed that the OR of Group C for clinical pregnancy (OR ​= ​1.849, P ​= ​0.040) and for LBR (OR ​= ​1.915, P ​= ​0.034) were significant using Group A as the base level. ConclusionsOur study has demonstrated that patients with higher serum LH levels (5.0–10.0 IU/L) on trigger day in the GnRH antagonist protocol may confer better clinical outcomes than those with lower LH levels (<1.0 IU/L).

Comparative characteristics of endocrine profile in males with infertility as well as in adolescents with varicocele

Introduction. Male infertility poses a pressing issue due to escalating prevalence of males with reproductive system diseases, the most common among which is varicocele being diagnosed in childhood and adolescence. Measuring level of hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and estradiol is the key element while assessing the reproductive male potential.Aim: to compare the parameters of hormonal status in adolescents with varicocele as well as males with diagnosed infertility and identify predictors of hypogonadism in pubertal period.Materials and Methods. Males with diagnosed infertility as well fertile males underwent a single measurement of serum FSH, LH, testosterone and estradiol levels. Adolescents with/without varicocele were measured the serum hormones noted above in dynamics annually between studies for the period within the 14 to 17 years of age. The data obtained were compared in infertile and fertile males, adolescents with/without varicocele, as well as assessed hormone status between different age groups in both cohorts and adolescents aged 17 years.Results. Our study allowed to identify significant differences in hormone level in male patients with infertility and varicocele lacking reproductive pathology. Infertile males had significantly higher levels of LH and estradiol (for both: p &lt; 0.001). The LH level in infertile vs. fertile males was 5.01 ± 2.69 IU/L vs. 3.40 ± 1.17 IU/L, respectively, whereas estradiol level was 136.51 ± 92.79 pmol/l and 82.49 ± 48.33 pmol/l, respectively that might indicate at lowered testosterone level. Fifteenand sixteen-year-old-adolescents with varicocele had significantly lower LH level: 15 years old – 3.72 ± 1.92 IU/L vs. 2.71 ± 1.65 IU/L (p &lt; 0.0123) in subjects without vs. with varicocele; 16 years old – 3.42 ± 1.16 IU/L vs. 2.81 ± 1.66 IU/L (p &lt; 0.0381) in subjects without vs. with varicocele. It may account for decreased testosterone level. Active puberty in adolescents is accompanied by dynamically increased testosterone levels. Starting from the age of 15 years, adolescents with varicocele had significantly increased testosterone level in each subsequent age group. Thus, at 14 and 15 years of age, testosterone level in adolescents with varicocele was 10.61 ± 4.70 nmol/l and 13.60 ± 5.64 nmol/l (p &lt; 0.0001), respectively, whereas at 16 and 17 years of age it continued to rise reaching 16.65 ± 6.44 nmol/l (p &lt; 0.001) and 19.22 ± 7.36 nmol/l (p &lt; 0.0160), respectively. In contrast, age-matched adolescents without varicocele had significantly elevated testosterone level solely at age of 15 vs. 14 years. Whereas at 14 years of age testosterone level in comparison group was 15.73 ± 7.2 nmol/l, at 15 years of age it was significantly increased up to 21.45 ± 9.51 nmol/l (p &lt; 0.0113). In the subsequent age categories of this group, no significant difference in testosterone level was found. While comparing such parameter between the main and control adolescent groups, testosterone level was significantly higher in adolescents lacking varicocele at the age of 14, 15 and 16 years compared with age-matched subjects with varicocele. At 14 years of age, testosterone level in adolescents without/with varicocele was 15.73 ± 7.2 nmol/l vs. 10.61 ± 4.7 nmol/l (p &lt; 0.0007), respectively, at 15 years of age – 21.45 ± 9.57 nmol/l vs. 13.60 ± 5.64 nmol/l (p &lt; 0.0001), respectively, at 16 years of age – 20.02 ± 5.84 nmol/l vs. 16.65 ± 6.44 nmol/l (p &lt; 0.0268), respectively. The FSH level in infertile males and adolescents with varicocele was 5.16 ± 2.67 IU/L and 4.1 ±2.63 IU/L (p &lt; 0.0081), whereas LH level was 5.01 ± 2.69 IU/L and 2.76 ± 1.65 IU/L (p &lt; 0.04), respectively. In adolescents with varicocele and infertile males, estradiol level was 177.45 ± 70.63 pmol/l and 136.51 ± 92.79 pmol/l (p &lt; 0.001), respectively. While comparing hormone levels in fertile males and adolescents lacking varicocele, a significantly higher estradiol level was found in adolescents 181,87 ± 27.14 pmol/l vs. 82.49 ± 48.33 pmol/l (p &lt; 0.001).Conclusion. A study of the hormonal status in infertile vs. fertile males revealed decreased testosterone production accompanied with higher levels of LH and estradiol. Due to profound changes in LH and testosterone levels detected in adolescents with varicocele as well as in infertile males, it is plausible that such hormones may serve as predictors of hypogonadism in the pubertal period. Adolescents with varicocele taking into consideration progressive course of the disease and verified lower testosterone level require further monitoring of hormone level to prevent endocrine infertility.

Suboptimal response to GnRH agonist trigger: causes and practical management.

GnRH agonist products are used extensively worldwide to trigger ovulation and final oocyte maturation in in vitro fertilization cycles. The purpose of this article is to outline possible causes for a suboptimal response to the GnRH agonist trigger. Risk factors for such a suboptimal response include prolonged hormonal contraceptive use, previous GnRHa-induced pituitary downregulation, a hypogonadotropic/hypogonadal condition, patient error, environmental conditions that may damage the GnRHa product used, GnRH and luteinizing hormone (LH) receptors polymorphisms, low baseline LH and low endogenous serum LH levels on trigger day as well as low BMI. The induction of an adequate LH surge can be ascertained by an LH urine test 12 h post trigger. In most cases, GnRHa trigger elicits effective LH+follicle stimulating hormone surges, resulting in mature, fertilizable oocytes. Clinical awareness to conditions that may predispose to a suboptimal response to the GnRHa trigger may prevent failed oocyte retrial.