AUTHOR=Benmachiche Abdelhamid , Benbouhedja Sebti , Zoghmar Abdelali , Humaidan Peter 

TITLE=Low LH Level on the Day of GnRH Agonist Trigger Is Associated With Reduced Ongoing Pregnancy and Live Birth Rates and Increased Early Miscarriage Rates Following IVF/ICSI Treatment and Fresh Embryo Transfer

JOURNAL=Frontiers in Endocrinology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2019.00639

DOI=10.3389/fendo.2019.00639

ISSN=1664-2392

ABSTRACT=<p><bold>Objective:</bold> To examine the correlation between serum luteinizing hormone (LH) levels on the day of GnRH agonist (GnRH-a) trigger and reproductive outcomes following <italic>in vitro</italic> fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment and fresh embryo transfer, and to identify a pre-trigger serum LH threshold which would be compatible with the most optimal cycle outcome.</p><p><bold>Design:</bold> This study is based on data from a previously published randomized controlled trial conducted from 2014 to 2016.</p><p><bold>Patients:</bold> A total of 322 participants were enrolled.</p><p><bold>Setting:</bold> Private IVF center. Intervention(s): GnRH-antagonist-based IVF cycles triggered with GnRH-a. For the purpose of the study, patients were stratified according to preovulatory LH quartiles (Q1-Q4). Main Outcome Measure(s): Ongoing pregnancy rates (OP), live birth rates (LB) and early pregnancy loss (EPL) rates.</p><p><bold>Results:</bold> The results of the present study showed increasing OP as well as LB rates and decreasing EPL rates with increasing pre-trigger serum LH levels (<italic>P</italic> for trend &lt; 0.06, 0.07, and 0.02), respectively. The absolute difference between the highest LH(Q4) and the lowest LH (Q1) group was 13.4%, 12.1%, and 12% in OP, LB, and EPL rates, respectively. In multivariate regression analysis, a pre-trigger serum LH level of 1.60 mIU/ml was identified as a threshold below which reproductive outcomes decreased. The ROC curve values were statistically significant for OP, LB, and EPL; the AUC (95% CI) = [0.57 (0.50–0.63) <italic>P</italic> &lt; 0.04; 0.57 (0.50–0.63) <italic>P</italic> &lt; 0.05, and 0.60 (0.51–0.70) <italic>P</italic> &lt; 0.04], respectively. A significant positive correlation was found on the day of GnRH-a trigger between serum LH, the number of follicles, serum P4, and serum E2, <italic>p</italic> &lt; 0.03; <italic>P</italic> &lt; 0.03; and <italic>P</italic> &lt; 0.001, respectively.</p><p><bold>Conclusion:</bold> Low serum LH levels on the day of GnRH-a trigger is associated with reduced ongoing pregnancy and live birth rates and increased early miscarriage rates. Our findings suggest a lower threshold of serum LH values on the day of GnRH-a trigger necessary to optimize reproductive outcomes in fresh embryo transfer cycles.</p><p><bold>Clinical Trial Registration</bold>: <ext-link ext-link-type="uri" xlink:href="http://www.ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">www.ClinicalTrials.gov</ext-link>, Number: 02053779</p>