The impact of the trigger day progesterone, luteinizing hormone and their interaction on live birth rates in GnRH antagonist cycles

IF 1.5 4区医学 Q3 OBSTETRICS & GYNECOLOGY Journal of Obstetrics and Gynaecology Research Pub Date : 2025-01-06 DOI:10.1111/jog.16181

Onur Ince MD, MSc, Bulent Yilmaz MD

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Abstract

Aim

This study aims to assess the impacts of various trigger day progesterone (P₄) and luteinizing hormone (LH) levels on live birth rates (LBRs) in fresh in vitro fertilization (IVF) cycles, considering their elevation from stimulation and premature luteinization.

Methods

This retrospective cohort study included the first ovarian stimulation cycles with GnRH antagonist protocol of 1253 patients who underwent intracytoplasmic sperm injection and fresh embryo transfer at a tertiary clinic's IVF center between 2010 and 2016. Participants were divided into four groups based on trigger day serum P₄ and LH levels, using the 90th percentile thresholds for P₄ (1.7 ng/mL) and LH (5.2 IU/L). The primary outcome measure was LBR.

Results

The LBRs observed in the respective groups were as follows: P₄ < 1.7 ng/mL and LH <5.2 IU/L (21.3%, 214/1005); P₄ < 1.7 ng/mL and LH ≥5.2 IU/L (19.1%, 22/115); P₄ ≥ 1.7 ng/mL and LH <5.2 IU/L (19.3%, 23/119); and P₄ ≥ 1.7 ng/mL and LH ≥5.2 IU/L (28.6%, 4/14). There were no statistically significant differences between the groups (p = 0.782). Additionally, a multivariate generalized additive model, adjusted for female age, body mass index, infertility duration, number of embryos transferred, and embryo transfer day, found that the interaction between LH and P₄ levels did not significantly predict LBRs (p = 0.533). However, univariate analysis identified an optimal trigger day P₄ range between 0.58 and 1.69 ng/mL for achieving higher LBRs, demonstrating a non-linear relationship. Furthermore, total FSH and LH dosages during stimulation had a statistically significant combined effect on trigger day P₄ levels (p = <0.001), with the addition of LH leading to lower P₄ levels compared to cycles stimulated with recombinant FSH alone.

Conclusions

The relationship and interaction between trigger day LH and P₄ levels do not significantly influence LBRs, as variations in LH do not alter the effect of P₄, suggesting that the impact of P₄ elevation on LBRs is independent of its cause, whether from ovarian stimulation or premature luteinization.

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GnRH拮抗剂周期中触发日黄体酮、黄体生成素及其相互作用对活产率的影响

目的本研究旨在评估不同触发日黄体酮（P4）和黄体生成素（LH）水平对体外受精（IVF）周期中活产率（lbr）的影响，考虑刺激和过早黄体生成素的升高。方法回顾性队列研究纳入2010年至2016年在某三级临床IVF中心接受卵胞浆内单精子注射和新鲜胚胎移植的1253例GnRH拮抗剂方案的第一个卵巢刺激周期。参与者根据触发日血清P4和LH水平分为四组，使用P4 （1.7 ng/mL）和LH （5.2 IU/L）的第90百分位阈值。主要结局指标为LBR。结果各组患者lbr分别为：P4 < 1.7 ng/mL、LH < 5.2 IU/L (21.3%, 214/1005)；P4 & lt; 1.7 ng / mL, LH≥5.2 IU / L (19.1%, 22/115);P4≥1.7 ng / mL和LH & lt; 5.2 IU / L (19.3%, 23/119);和P4≥1.7 ng / mL, LH≥5.2 IU / L(28.6%, 4/14)。两组间差异无统计学意义（p = 0.782）。此外，一个多变量广义加性模型，调整了女性年龄、体重指数、不孕持续时间、移植胚胎数量和胚胎移植天数，发现LH和P4水平的相互作用不能显著预测lbr （p = 0.533）。然而，单变量分析发现，实现更高lbr的最佳触发日P4范围在0.58至1.69 ng/mL之间，证明了非线性关系。此外，刺激期间的FSH和LH总剂量对触发日P4水平有统计学意义的联合影响（p = <0.001），与单独使用重组FSH刺激周期相比，添加LH导致P4水平降低。结论触发日LH和P4水平之间的关系和相互作用对lbr没有显著影响，因为LH的变化不会改变P4的作用，这表明P4升高对lbr的影响与其原因无关，无论是卵巢刺激还是黄体早衰。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.