Basal and Down-regulated Serum LH Levels as a Prognostic Indicator of Ovarian Response to Controlled Ovarian Hyperstimulation

Lee, Kook One; Seo, Dong Soo; Jo, Moo Sung; Jung, Eun Joo; Kim, Ki Hyung; Lee, Kyu Sup

Abstract

OBJECTIVE
The effect of basal day 3 luteinizing hormone (LH) and pituitary desensitized day 3 LH level on ovarian response to controlled ovarian hyperstimulation were investigated.
METHODS
From January 1999 to December 2001, 445 cycles for in vitro fertilization and embryo transfer (IVF-ET) were allocated to this study. Controlled ovarian hyperstimulation (COH) was performed using long protocol of gonadotropin-releasing hormone agonist (GnRHa). All patients included in this study had blood samples drawn on cycle day 3 prior to COH and cycle day 3 after pituitary desensitization with GnRHa for measurement of FSH and LH. Infertile women were younger than 43 years old, and had normal menstrual cycle, normal day 3 FSH and LH level (<10 mIU/ml), infertility factor caused by tubal factor, mild endometriosis, unexplained infertility or mild male subfertility. The result of COH and IVF-ET were compared between low LH group and high LH group according to the level of basal LH (3 mIU/ml) and down-regulated LH (1 mIU/ml).
RESULTS
The low LH groups were significantly higher FSH:LH ratio, higher dose of exogenous gonadotropin for pituitary desensitization, longer duration of gonadotropin administration. The peak estradiol, number of oocytes retrieved, number of MII oocyte, mean cumulative embryo score (MCES) were significantly lower in the low LH group than the high LH group. There were not significantly differentiation in the duration of pituitary desensitization, fertilization rate and the number of transferred embryos. The clinical pregnancy rate per cycle was not correlated with the value of basal LH concentration, but correlated with the value of down-regulated LH concentration.
CONCLUSION
The lower LH activity (basal LH <3 mIU/ml, down-regulated LH <1 mIU/ml) is significantly associated with reduced ovarian response in controlled ovarian hyperstimulation after desensitization with GnRHa. These results suggest that down-regulated LH level 1 mIU/ml may be a useful predictor of the clinical pregnancy rate per cycle after controlled ovarian hyperstimulation.