Do raised serum luteinizing hormone levels during stimulation for in-vitro fertilization predict outcome?
ABSTRACT Previous reports associating raised LH concentrations with reduced fertilization and pregnancy rates in women undergoing in-vitro fertilization (IVF) have assumed a Gaussian distribution of LH values with IVF treatment. We have determined the serum LH range during ovarian stimulation for IVF with a single regimen of clomiphene citrate/hMG from 102 consecutive IVF conception cycles. The results show a non-Gaussian distribution of LH values. Application of this LH range to a consecutive series of 596 women undergoing IVF treated with this single regimen showed no difference in pregnancy rates, fertilization rates, median number of oocytes fertilized or retrieved when analysed with respect to serum LH concentrations above the 75th or 95th centile for greater than or equal to 3 days of an IVF treatment cycle. We conclude that follicular-phase LH concentrations do not predict IVF fertilization rates or clinical outcome and are not clinically useful in individual patient management.
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ABSTRACT: The aim of this study was to investigate whether the endogenous serum luteinizing hormone (LH) discharge in stimulated cycles--either simultaneously with or shortly after exogenous human chorionic gonadotropin (hCG) administration--is influenced by serum steroid hormones and follicle stimulating hormone (FSH). We also tested whether the LH discharge affects intrafollicular hormone metabolism and oocyte fertilization. In a group of 46 women with tubal pathology who were undergoing in vitro fertilization (IVF), follicular fluids were collected during oocyte retrieval. In addition blood samples were drawn daily, starting at cycle day 7 until the day of oocyte retrieval. LH, FSH, estradiol, progesterone, testosterone and prolactin were determined in all samples of serum and follicular fluid. Oocyte maturation was classified according to the morphology of the oocyte corona-cumulus complex. Of the 46 women studied, 15 showed no LH surge (group A) and 31 developed an endogenous LH surge (group B). Serum samples showed no significant differences between the two groups in follicular phase estradiol, progesterone, testosterone and prolactin. Only levels of serum FSH showed a significant difference between groups A and B (p < 0.0005). In follicular fluid samples LH (p < 0.05) and FSH levels (p < 0.005) were significantly different. Fertilization rate and cleavage rate, however, did not differ significantly. The late endogenous LH surge occurring simultaneously with or shortly after hCG application for ovulation induction did not affect intrafollicular steroid metabolism, oocyte maturation, fertilization rate or cleavage rate.Gynecological Endocrinology 01/1995; 8(4):227-32. · 1.30 Impact Factor