The effect of adding exogenous LH to IVF/ICSI cycles on pregnancy outcomes in elderly women with PCOS: a retrospective cohort study

Abstract

Background Current findings on the necessity of adding exogenous luteinizing hormone (LH) to IVF/ICSI cycles in elderly women(≥ 35 years) with Polycystic ovary syndrome（PCOS）are controversial. This study investigated the clinical efficacy of adding exogenous LH to antagonist regimens in IVF/ICSI-assisted conception cycles for elderly patients with PCOS. Methods Clinical data of PCOS patients who underwent IVF/ICSI-assisted conception at Reproductive and Genetic Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine， between January 1, 2018, and April 30, 2022, were collected for retrospective cohort analysis. Groups 1 (exogenous follicle-stimulating hormone (FSH) only, n = 170) and 2 (exogenous FSH and LH, n = 265) were divided according to whether exogenous LH was added to the gonadotropin-releasing hormone antagonist (GnRH-ant) regimen. controlled ovarian hyperstimulation (COH) and conception outcomes were compared between the two groups， and binary logistic regression analysis was used to examine the association between the addition of exogenous LH and pregnancy outcome. Results The number of follicles ≥ 14 mm on trigger day（12.70±8.56 vs 11.08±6.84，P=0.025）, eggs obtained（13.28±9.02 vs 11.31±6.03，P=0.003）, fertilized eggs（10.79±7.87 vs 10.02±5.75，P=0.047）, normally fertilized eggs（8.07±6.47 vs 6.84±4.53，P=0.005）, and high-quality embryos（1.62±2.10 vs 1.01±1.41，P＜0.001）, and the cumulative clinical pregnancy rate（65.9% vs 49.1%，P=0.001）were significantly higher in group 1 than in group 2 (P < 0.05). The binary logistic regression indicated that adding exogenous LH was an independent risk factor for cumulative clinical pregnancy rate (OR = 2.024, P = 0.001). Conclusion For most elderly women with PCOS, particularly those with body mass index (BMI) < 25 kg/m2, the addition of exogenous LH during IVF/ICSI cycles resulted in decreased efficacy in assisted conception outcomes.