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The Effect of Luteinising Hormone Suppression in In Vitro Fertilisation Antagonist Cycles

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Abstract

Use of GnRH antagonists in IVF stimulation protocols shortens controlled ovarian hyperstimulation (COH) and reduces the risk of ovarian hyperstimulation syndrome (OHSS). However, profound reduction in LH levels has been associated with use of GnRH antagonists. This study aims to determine if LH suppression during GnRH antagonist cycles results in poorer IVF outcomes. This was a prospective pilot longitudinal study where serum LH levels were measured on day 2/3 of the menstrual cycle before COH, 1/2 days following institution of GnRH antagonist and at the day of ovulation trigger. A threshold of LH <0.5 IU/L was used to define profound LH suppression. Data on IVF outcomes was collected. Logistic regression analysis was used to investigate risk factors associated with LH suppression following GnRH antagonist IVF treatment. Ninety-one eligible women were recruited. Women underwent a standard antagonist cycle with Puregon 200u and Ganirelix. No participant had LH <0.5 IU/L prior to GnRH antagonist treatment, and 27 participants (29.7%) had significant LH suppression at either time point. Predictors of profound LH suppression following GnRH antagonist treatment identified (P < 0.20) were age (OR = 0.80, P = 0.013), no previous ovulation induction (OR = 0.26, P = 0.033) and previous GnRH antagonist IVF cycle (OR = 4.32, P = 0.125). Numbers of oocytes, embryos and ongoing pregnancy rates at 12 weeks gestation in patients with and without LH suppression did not differ significantly. We found associations between clinical characteristics and risk of profound LH suppression in women undergoing GnRH antagonist IVF cycles, but no significant differences in IVF and pregnancy outcomes between women with and without significant LH suppression.

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The data are not publicly available due to confidentiality and ethical restrictions.

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Funding

This study was funded by the SingHealth-Duke-NUS Obstetrics and Gynaecology Academic Clinical Program Research Grant.

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Authors and Affiliations

  1. Division of Obstetrics and Gynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Jody Paige Goh

  2. Department of Obstetrics and Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Jody Paige Goh

  3. Department of Urogynaecology, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

    Jill Cheng Sim Lee

  4. Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, 229899, Singapore

    Jerry Kok Yen Chan, Xiang Wen Ng, Sadhana Nadarajah, Jessie Wai Leng Phoon & Shuling Liu

  5. Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore, 169857, Singapore

    Jerry Kok Yen Chan

  6. Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore

    John Carson Allen

Authors
  1. Jody Paige Goh
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  2. Jill Cheng Sim Lee
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  3. Jerry Kok Yen Chan
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  6. Sadhana Nadarajah
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  7. Jessie Wai Leng Phoon
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Corresponding authors

Correspondence to Jody Paige Goh or Jill Cheng Sim Lee.

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This study was conducted in accordance with the ethics standards stated in the Declaration of Helsinki and was reviewed and approved by the SingHealth Centralised Institutional Review Board for ethics approval. Written informed consent was obtained from all participants.

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The authors declare no competing interests.

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Goh, J.P., Lee, J.C.S., Chan, J.K.Y. et al. The Effect of Luteinising Hormone Suppression in In Vitro Fertilisation Antagonist Cycles. Reprod. Sci. 28, 3164–3170 (2021). https://doi.org/10.1007/s43032-021-00608-0

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  • DOI: https://doi.org/10.1007/s43032-021-00608-0

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