A Premature Rise of Luteinizing Hormone Is Associated With a Reduced Cumulative Live Birth Rate in Patients ≥37 Years Old Undergoing GnRH Antagonist In Vitro Fertilization Cycles

Gao, Fumei; Wang, Yanbin; Wu, Dan; Fu, Min; Zhang, Qiuxiang; Ren, Yumeng; Yang, Zhen; Shen, Huan; Han, Hua

doi:10.3389/fendo.2021.722655

Cited by 11 publications

(8 citation statements)

References 23 publications

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“…The result demonstrated that the P level on the trigger day was not an independent predictive factor of CLBR. The confounders included in the multivariate logistic model have been consistently reported to be associated with CLBR in previous studies [20][21][22]. The results of the present study are supported by another retrospective analysis of fresh oocyte donation cycles, which showed that excluding the detrimental effect of LFPE on endometrial receptivity, LFPE does not influence CLBR [4].…”

Section: Discussionsupporting

confidence: 86%

The Impact of Late Follicular Phase Progesterone Elevation on Cumulative Live Birth Rate and Embryo Quality in 4072 Freeze-All Cycles

Huang

Wen

et al. 2022

JCM

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Late follicular phase progesterone elevation during in vitro fertilization impedes embryo implantation. It is unclear whether late follicular phase progesterone elevation still has a negative effect on cumulative live births and embryo quality when a freeze-all strategy is adopted. Data from a total of 4072 patients were reviewed. All patients used the freeze-all strategy. Multivariate regression analyses were used to assess the association of progesterone levels with both cumulative live birth and embryo quality. There was no significant difference in the cumulative live birth rate between the groups with progesterone level <1.5 ng/mL and ≥1.5 ng/mL. The progesterone level was not associated with cumulative live birth and embryo quality.

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Section: Discussionsupporting

confidence: 86%

The Impact of Late Follicular Phase Progesterone Elevation on Cumulative Live Birth Rate and Embryo Quality in 4072 Freeze-All Cycles

Huang

Wen

et al. 2022

JCM

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“…According to the analysis strati ed by ovarian response, a transient LH rise was not associated with a decline in pregnancy outcomes. Gao et al reported that the premature LH rise was associated with decreased rates of cumulative live birth rate in patients of advanced age (≥ 37 years) [11]. The inconsistent nding may be due to that they did not exclude the accompanying elevated serum progesterone level.…”

Section: Discussionmentioning

confidence: 99%

“…Only one study has reported the effect of a premature LH surge on the cumulative live birth rate (CLBR). The result indicated that the premature LH rise was associated with decreased rates of cumulative live birth rate in patients of advanced age (≥ 37 years) [11]. The limitation of the above study was that it did not exclude the accompanying elevated serum progesterone level.…”

Section: Introductionmentioning

confidence: 88%

A premature luteinizing hormone surge without elevated progesterone levels has no adverse effect on cumulative live birth rate in patient undergoing a flexible GnRH antagonist protocol: a retrospective study

Zhang

et al. 2022

Preprint

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Background A premature luteinizing hormone (LH) surge refers to an endogenous LH peak that occurs before follicle maturation or human chorionic gonadotropin injection in the process of controlled ovarian hyperstimulation. The effect of premature LH surge on pregnancy outcomes in fresh embryo transfer cycles is still controversial. The aim of this study was to explore the effect of a premature LH surge without elevated progesterone levels on the cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) of patients during a flexible GnRH antagonist protocol. Methods A total of 428 infertile women undergoing IVF/ICSI were recruited for this retrospective study. Only women who either delivered a live infant or had no remaining frozen embryos after a single stimulation cycle were included in the analysis. During the study period, each patient underwent a flexible GnRH antagonist protocol. Women were divided into two groups according to the presence or absence of a premature LH surge. The primary outcome measures were the CPR and CLBR per ovarian stimulation cycle. The secondary outcome measures were the number of oocytes retrieved, fertilization rate, good-quality embryo rate, and clinical pregnancy rate. Results Fifty-one women (11.92%) experienced a premature LH surge, and the other 377 (88.08%) women were assigned to the control group. The numbers of oocytes retrieved was significantly greater in the premature LH surge group than in the control group. There was no significant difference between groups in the fertilization rate, good-quality embryo rate, clinical pregnancy rate or live birth rate in the fresh embryo transfer cycle. The primary outcome measures, the CPR and CLBR per ovarian stimulation cycle, were not significantly different between the premature LH surge group and the control group. According to the analysis stratified by ovarian response (normal or high), there were no significant differences in pregnancy outcomes between the groups with and without a premature LH surge. Conclusions Our study demonstrated that a transient premature LH surge without progesterone elevation had no adverse effect on the CLBR of patients on a flexible GnRH antagonist protocol. Therefore, a transient LH surge should not be an indicator for cycle cancellation.

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“…In terms of premature LH surge rate, the two strategies showed a similar result (23.1% vs 25.2%, P=0.730), but the women in our study seem more likely to have premature LH surge during COS compared with previous studies ( 15 – 17 ). Numerous studies have reported low serum LH level ( 18 , 19 ), as well as high serum LH level during COS ( 9 , 19 ), would impair pregnancy and live birth outcomes. When it comes to the choice of GnRH-ant initiation strategy, according to previous studies, the inhibition effect of GnRH-ant on LH level did not differ between fixed or flexible GnRH-ant protocols, which are in accordance with our results ( 16 , 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…Women at AMA are a population with expected poor IVF-ET outcomes, and none of the current treatments or strategies showed truly uplifting results ( 6 , 7 ). According to previous studies, in addition to ovarian aging, AMA women also have the characteristics of a “relative LH deficiency” and are more prone to a “premature LH surge”, hence the dissatisfying outcomes ( 8 , 9 ). In light of these findings, the question arises: when is the optimal time to initiate GnRH-ant in AMA women in order to stabilize serum LH levels within a reasonable range and to optimize IVF-ET outcomes?…”

Section: Introductionmentioning

confidence: 99%

Optimal timing of GnRH antagonist initiation in IVF-ET: a retrospective cohort study on advanced maternal age women

Han,

Zhou,

et al. 2024

Front. Endocrinol.

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BackgroundSeveral studies have compared the effects of fixed and flexible gonadotropin releasing hormone antagonist (GnRH-ant) protocols during in vitro fertilization and embryo transfer (IVF-ET). However, which GnRH-ant initiation strategy is better remains controversial. Moreover, no studies have assessed the optimal timing of GnRH-ant initiation in women of advanced maternal age (AMA).MethodsIn this retrospective cohort study, a total of 472 infertile women aged ≥ 35 years old undergoing their first IVF cycle from August 2015 to September 2021 at a tertiary academic medical center were recruited, of whom 136 followed fixed GnRH-ant protocol and 336 followed flexible GnRH-ant protocol. The primary outcomes measured were the cumulative live birth rate (CLBR) per IVF cycle and the time to live birth (TTLB) from the date of oocyte retrieval. Cox proportional models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI) of CLBR regarding GnRH-ant timing.ResultsNo significant difference in CLBR was found between the fixed and flexible GnRH-ant groups (27.9% vs 20.5%, p=0.105). The TTLB was also comparable between groups (10.56 vs 10.30 months, p=0.782). The Kaplan-Meier analysis for CLBR also showed comparable results between groups (P=0.351, HR=0.83; 95%CI: 0.56-1.23). After establishing a multiple Cox proportional hazard model, the fixed GnRH-ant group still had comparable CLBR with the flexible GnRH-ant group (HR=0.85; 95%CI: 0.53-1.38; P=0.518). Subgroup and sensitivity analyses also demonstrated similar results.ConclusionGnRH-ant protocols can be tailored to the needs of AMA women, and timing of GnRH-ant initiation can be adjusted flexibly.

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A Premature Rise of Luteinizing Hormone Is Associated With a Reduced Cumulative Live Birth Rate in Patients ≥37 Years Old Undergoing GnRH Antagonist In Vitro Fertilization Cycles

Cited by 11 publications

References 23 publications

The Impact of Late Follicular Phase Progesterone Elevation on Cumulative Live Birth Rate and Embryo Quality in 4072 Freeze-All Cycles

The Impact of Late Follicular Phase Progesterone Elevation on Cumulative Live Birth Rate and Embryo Quality in 4072 Freeze-All Cycles

A premature luteinizing hormone surge without elevated progesterone levels has no adverse effect on cumulative live birth rate in patient undergoing a flexible GnRH antagonist protocol: a retrospective study

Optimal timing of GnRH antagonist initiation in IVF-ET: a retrospective cohort study on advanced maternal age women

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