AUTHOR=Liu Minghui , Liu Shan , Li Lingxiu , Wang Peng , Li Huanhuan , Li Yuan 

TITLE=LH Levels May Be Used as an Indicator for the Time of Antagonist Administration in GnRH Antagonist Protocols—A Proof-Of-Concept Study

JOURNAL=Frontiers in Endocrinology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2019.00067

DOI=10.3389/fendo.2019.00067

ISSN=1664-2392

ABSTRACT=<p><bold>Objective:</bold> To investigate whether circulating LH levels could be used as an indicator for the timing of antagonist addition in GnRH antagonist protocol.</p><p><bold>Design:</bold> Retrospective cohort study.</p><p><bold>Setting:</bold> University-based hospital.</p><p><bold>Patients:</bold> A total of 567 women stimulated with recombinant FSH monotherapy in a GnRH antagonist protocol were studied. Among them, 256 patients showed relatively low LH levels [highest LH level (LHmax) &lt; 4 IU/L] during the entire ovarian stimulation process; 88 (Group A) and 168 patients (Group B) were stimulated without and with antagonist co-treatment, respectively. The remaining 311 patients had LHmax≥4 IU/L and were stimulated with a modified flexible antagonist protocol based on LH levels (Group C).</p><p><bold>Intervention(s):</bold> Patients in Group B and C received antagonist during ovarian stimulation, whereas patients in Group A did not.</p><p><bold>Main outcome measure:</bold> Clinical pregnancy rate and ongoing pregnancy rate.</p><p><bold>Results:</bold> The clinical and ongoing pregnancy rates were significantly higher in group A than group B (69.3 vs. 54.7%, <italic>P</italic> = 0.03 and 62.5 vs. 48.2%, <italic>P</italic> = 0.04, respectively), but the primary outcome measures did not differ between groups B and C. There were no significant differences in terms of patient demographics, LH levels, total dosage of gonadotrophin, duration of stimulation, follicular output rate between groups A and B, and between groups B and C. Also, there were no significant differences in laboratory and clinical outcomes in pairwise group comparisons. No canceled cycles due to premature ovulation was reported among the treated patients.</p><p><bold>Conclusion:</bold> LH levels may be used as an indicator for the time of antagonist addition. Patients with sustained low LH levels (LHmax&lt;4 IU/L) during controlled ovarian stimulation (COS) might not require antagonist administration. Although further well-designed randomized controlled trials (RCTs) are needed to confirm our results, a novel treatment regimen based on LH measurements during COS might provide clinicians new insights about when to start antagonist administration in the GnRH antagonist protocol.</p>