Influence of early elevation of LH with flexible GnRH antagonist protocol on clinical outcomes of IVF/ICSI fresh embryo transfer: a propensity score matching study
10.3760/cma.j.cn101441-20221116-00511
- VernacularTitle:拮抗剂灵活方案促排卵LH提前升高对IVF/ICSI鲜胚移植临床结局的影响：一项倾向评分匹配研究
- Author:
Jiangdi HUANG
1
;
Ruxue YANG
;
Xiaozhen DONG
;
Danyang LI
;
Ying XU
;
Ya ZHANG
;
Lijun SUN
Author Information
1. 郑州大学第三附属医院生殖医学中心，郑州 450052
- Publication Type:Journal Article
- Keywords:
Ovarian reserve;
Gonadotropin-releasing hormone antagonist flexible protocol;
Luteinizing hormone;
Clinical outcomes
- From:
Chinese Journal of Reproduction and Contraception
2023;43(12):1244-1248
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the effect of early elevation of luteinizing hormone (LH) with flexible gonadotropin-releasing hormone antagonist (GnRH-A) protocol on pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo transfer. Methods:A retrospective cohort study was conducted to analyze patients with normal ovarian reserve function who underwent IVF/ICSI with flexible GnRH-A protocol at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to September 2021. According to the level of LH before antagonist addition, the patients were divided into two groups, group A: early elevation of LH (LH >10 U/L before the addition of antagonist, n=65), group B: the patients whose LH≤10 U/L before the addition of antagonist ( n=193), which was matched with group A using the 1∶3 propensity score matching by age, duration of infertility, anti-Müllerian hormone, body mass index and antral follicle count. The general conditions, clinical data, embryonic laboratory indicators and clinical outcomes were compared between the two groups. Results:There were no significant differences in the baseline characteristics between the two groups (all P>0.05). There were no significant differences in basic LH levels, gonadotropin (Gn) initiation dosage, total dosage and duration of Gn used, duration of Gn used when adding antagonists and estradiol (E 2) level on the trigger day between group A and group B (all P>0.05). The LH level [12.2 (11.1, 17.5) U/L], E 2 level [3 301.0 (2 708.0, 4 275.0) pmol/L] and follicle diameter [14.0 (12.6, 15.5) mm] were significantly higher in group A than in group B [3.5 (2.2, 5.2) U/L, 2 178.5 (1 208.0, 3 218.0) pmol/L, 13.0 (12.0, 14.0) mm] when adding antagonist (all P<0.001). The level of LH in group A decreased rapidly after adding antagonist, LH level in group A after antagonist application [3.4 (2.0, 5.2) U/L] and the LH level on the trigger day [3.0 (1.7, 4.7) U/L] were still higher than those in group B [2.1 (1.5, 3.3) U/L, P<0.001; 2.1 (1.4, 3.3) U /L, P=0.004], the level of progesterone on the trigger day was not significantly higher than that in group B ( P>0.05). There were no statistically significant differences in the number of oocytes retrieved, two pronuclei fertilization rate, the rate of high-quality embryo, the rate of blastocyst formation, endometrial thickness on the day of transplantation, the number of transferred embryos, the proportion of transferred blastocysts and the implantation rate between the two groups (all P>0.05). The clinical pregnancy rate, the early abortion rate, and the live birth rate were not statistically different between the two groups (all P>0.05). Conclusion:In patients with normal ovarian reserve, LH level was elevated early with antagonist flexible protocol, and decreased rapidly after the timely addition of antagonist, which did not lead to an increase of progesterone on the trigger day, and ultimately did not affect the clinical outcomes of IVF/ICSI fresh embryo transfer.
