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Hum. Reprod. Advance Access published online on June 19, 2006
Human Reproduction, doi:10.1093/humrep/del219
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received December 12, 2005
Revised March 26, 2006
Accepted May 3, 2006

Article

A relative reduction in mid-follicular LH concentrations during GnRH agonist IVF/ICSI cycles leads to lower live birth rates

R. Lahoud 1 *, M. Al-Jefout 2, J. Tyler 1, J. Ryan 1, and G. Driscoll 1

1 IVFAustralia
2 University of Sydney, Sydney, Australia

* To whom correspondence should be addressed.
R. Lahoud, E-mail: rlahoud{at}ivf.com.au


  Abstract

BACKGROUND: The effect of early- and mid-follicular LH concentrations on the ovarian response and pregnancy outcomes was evaluated in women receiving pituitary down-regulation with a GnRH agonist and ovarian stimulation with recombinant FSH (rFSH) during IVF/ICSI treatment. METHODS: Blood samples were collected prospectively from 701 cycles (560 patients) of assisted reproduction and analysed retrospectively. On the basis of LH concentrations on stimulation day 7/8, the patients were divided into two groups: LH < 1.2 IU/l (n = 179) and LH ≥ 1.2 IU/l (n = 522). Cycle outcomes were also compared on the basis of a ratio of mid- to early-follicular LH concentrations (≤0.5, n = 210; >0.5, n = 491). RESULTS: Patients with low LH concentrations were found to have a significant reduction in the late-follicular estradiol concentrations (P < 0.001), the number of oocytes retrieved (P < 0.01) and the number of usable embryos (P < 0.01), and they required significantly more rFSH (430 IU difference, P < 0.01). These differences did not translate into a significant change in live birth rates. Conversely, a ratio of ≤0.5 mid- to early-follicular LH concentrations (a reduction of ≥50%) was associated with a significant reduction in live birth rates per embryo transfer and per cycle started (27.3 versus 19.0%, P < 0.05 and 22.2 versus 15.8%, P < 0.05, respectively). CONCLUSIONS: Low mid-follicular levels of LH have a significant impact on ovarian response but not on live birth rates. A fall in LH level of ≥50% from the early- to mid-follicular phase resulted in a lower live birth rate.

Keywords: GnRH agonist/IVF/live birth rate/LH/pituitary suppression.
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