Effects of different exogenous LH activity drugs on pregnancy outcomes in patients with suboptimal ovarian response: a retrospective cohort study
10.3760/cma.j.cn101441-20220406-00144
- VernacularTitle:添加不同LH活性药物对卵巢慢反应患者妊娠结局的影响：一项回顾性队列研究
- Author:
Lin WANG
1
;
Jing WANG
1
;
Yan GAO
1
;
Mei LI
1
;
Lili NI
1
;
Jiayin LIU
1
;
Feiyang DIAO
1
Author Information
1. 南京医科大学第一附属医院生殖医学科，南京 210029
- Publication Type:Journal Article
- Keywords:
Suboptimal ovarian response;
Recombinant luteinizing hormone;
Human menopausal gonadotropins;
Follicular phase long protocol;
Cumulative live birth rate
- From:
Chinese Journal of Reproduction and Contraception
2023;43(8):769-776
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effects of recombinant luteinizing hormone (rLH) and human menopausal gonadotropins (hMG) supplementation on pregnancy outcomes for suboptimal ovarian responders undergoing follicular phase long protocol.Methods:The data of infertile patients who underwent in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) for the first time with follicular phase long protocol from January 2017 to January 2020 in Reproductive Medicine Center of the First Affiliated Hospital of Nanjing Medical University Hospital were retrospectively cohort analyzed. Totally 2 336 patients with normal ovarian reserve were included in the study with suboptimal ovarian response to ovarian stimulation. According to the different exogenous LH supplementation, they were divided into hMG group ( n=1 558) and rLH group ( n=778). The clinical features and effects of ovulation induction were compared between the two groups and reproductive outcomes were compared in both fresh embryo transfer cycles and subsequent frozen-thawed embryo transfer (FET) cycles. Logistic regression analysis were performed to explore the relationship between different LH activity drugs supplementation and the cumulative live birth rate of suboptimal ovarian responders. Results:The basic characteristics such as age, infertility type and diagnosis, body mass index and biomarkers of ovarian reserve were comparable between the two groups (all P>0.05). Total dosage [(2 088.98±628.24) U] and duration [(12.22±2.29) d] of FSH used in the hMG group were significantly higher than those in the rLH group [(1 866.90±602.65) U, P<0.001; (11.89±2.37) d, P=0.001]. Total dosage [(537.30±484.49) U] and duration [(7.40±3.52) d] of LH used in the hMG group were significantly higher than those in the rLH group [(498.10±472.04) U, (5.67±3.78) d, P<0.001]. The serum LH levels on the first day [(0.78±0.77) U/L] and the sixth day [(0.81±0.49) U/L] of gonadotropin stimulation in the hMG group were higher than those in the rLH group [(0.67±0.32) U/L, P<0.001; (0.71±0.33) U/L, P=0.002]. However, the serum LH level was comparable on the trigger day between the two groups without significant difference ( P=0.303). The levels of serum estrodiol [(8 377.14±7 000.63) pmol/L] and progesterone [(3.84±2.18) nmol/L] on the trigger day were significantly higher in the hMG group than in the rLH group [(7 644.91±5 145.64) pmol/L, P=0.009; (3.14±1.80) ng/L, P<0.001]. The pregnancy outcomes including clinical pregnancy rates, abortion rates and live birth rates were comparable between the two groups in fresh embryo transfer cycles and the subsequent FET cycles (all P>0.05). The cumulative pregnancy rate (CPR) [89.46% (696/778)] and the cumulative live birth rate (CLBR) [78.02% (607/778)] in the rLH group were significantly higher than those in the hMG group [84.60% (1 318/1 558), P=0.001; 72.98% (1 137/1 558), P=0.008]. Multivariate logistic regression analysis showed that age was a risk factor for CLBR ( OR=0.930, 95% CI: 0.906-0.955, P<0.001) and antral follicle count ( OR=1.029, 95% CI: 1.005-1.054, P=0.018), total number of oocytes retrieved ( OR=1.064, 95% CI: 1.029-1.100, P<0.001), the number of embryos transferred ( OR=1.714, 95% CI: 1.293-2.272, P<0.001), the stage of embryos transferred ( OR=1.567, 95% CI: 1.243-1.975, P<0.001), endometrial thickness on transfer day ( OR=1.122, 95% CI: 1.077-1.170, P<0.001) and rLH supplementation ( OR=1.348, 95% CI:1.101-1.651, P=0.004) were protective factors for CLBR of suboptimal responders. Conclusion:For suboptimal ovarian responders with normal ovarian reserve, rLH supplementation may achieve a higher CLBR than hMG supplementation in follicular phase long protocol.
