The effectiveness of earlier oocyte retrieval in the case of a premature luteinizing hormone surge on hCG day in in vitro fertilization-embryo transfer cycles

Diminished Ovarian Reserve Predisposes to Premature Luteinizing Hormone Surges in Gonadotropin-Releasing Hormone Antagonist Cycles in In vitro Fertilization

Context/Background:

A premature luteinizing hormone (LH) surge, in in vitro fertilization (IVF) cycles with gonadotropin-releasing hormone (GnRH)-antagonist downregulation, leads to cycle cancellation. Currently, risk factors for the development of premature LH surge remain unknown.

Objective:

The aim of the study was to determine the incidence and identify the contributing factors for premature LH surge in IVF cycles with GnRH antagonist suppression.

Design:

This was a retrospective cohort study.

Setting:

IVF-embryo transfer program at a fertility and research center.

Materials and Methods:

The study included all patients undergoing IVF from December 1, 2014, to November 30, 2018, in whom GnRH-antagonist (cetrorelix 0.25 mg/d) flexible protocol was used. The primary outcome measure was the identification of premature LH surges (documented by a 2.5-fold increase in LH from the baseline above a threshold of 17 mIU/mL) with or without a decrease in E₂ and appearance of free fluid on ultrasound.

Results:

Premature LH surges occurred in 15 (2.16%) of 692 patients undergoing IVF with GnRH-antagonist suppression. Patients with premature surges had significantly lower ovarian reserve as compared to the controls (as seen from their higher age group, higher day 2 follicle-stimulating hormone (FSH), lower antral follicle counts, and lower anti-Müllerian hormone).

Conclusions:

Premature LH surge in a GnRH-antagonist cycle can lead to cycle cancellation and disappointment. Although this is a rare event, the incidence is higher in patients with diminished ovarian reserve. Further studies are needed to determine if giving the human chorionic gonadotropin trigger a day earlier or giving higher doses of GnRH-antagonist can benefit such cases.

The effect of a transient premature luteinizing hormone surge without elevated serum progesterone on in vitro fertilization outcomes in a gonadotropin-releasing hormone antagonist flexible protocol

During controlled ovarian stimulation, the LH rising before triggering can lead to follicular luteinizations. However, LH can be suppressed immediately and no progesterone elevation with GnRH antagonist. This study retrospectively compared fresh IVF/ICSI cycle outcomes in antagonist protocols between the group with and the group without a premature LH surge. Logistic regression models were fitted to reduce the relevant confounders. Compared between premature LH surge group and control group, the implantation rates were 12.9% (30/233) vs 25.0% (141/536), p = .000; clinical pregnancy rates were 21.0% (25/119) vs 41.6% (119/286), p = .000; live birth rates were17.6% (21/119) vs 29.7% (85/286), p = .012. After adjusting for age, BMI, bFSH, and infertility factors, the adverse effects were still as pronounced for the clinical pregnancy rate (OR = 0.39, 95% CI = 0.24-0.66) and live birth rates (OR = 0.54, 95% CI = 0.32-0.93. In a GnRH antagonist flexible protocol, a transient premature LH surge which can be suppressed immediately after the initiation of antagonist without elevated serum progesterone, will cause a detrimental effect on the development of the embryo and IVF/ICSI pregnancy outcomes in fresh embryo transfer cycles.

Lipidomic Components Alterations of Human Follicular Fluid Reveal the Relevance of Improving Clinical Outcomes in Women Using Progestin-Primed Ovarian Stimulation Compared to Short-Term Protocol

BACKGROUND Increasing the success rate of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is a duty of clinicians that has made many seek a variety of protocols. This study was undertaken to use a liquid chromatography-mass spectrometry (LC-MS) to define the alterations of follicular fluid (FF) lipid metabolites in patients undergoing progestin-primed ovarian stimulation (PPOS) compared with short-term protocol, revealing potential correlations between the differentially expressed lipids and ameliorative clinical outcomes. MATERIAL AND METHODS Ninety-three infertile women undergoing IVF/ICSI treatment with PPOS (n=62) or a short-term protocol (n=31) were prospectively enrolled in a randomized controlled trial. FF samples were obtained from dominant follicles at the time of oocyte retrieval. Lipid metabolism profiles were analyzed using LC-MS. RESULTS Twelve lipids were found to be higher in patients treated with the PPOS protocol than in those receiving the short-term protocol, including triacylglycerols (TAG-34: 1+NH4, TAG-58: 0+NH4, TAG-64: 3+NH4, and TAG-64: 8+NH4), diacylglycerol DAG-38: 6+NH4, phosphatidylglycerols (PG-26: 0, PG-30: 2, and PG-40: 5), phosphatidylethanolamine PE-32: 2, lysophosphatidylethanolamine LPE-14: 1, lysophosphatidylinositol LPI-12: 0, and lysophosphatidylcholine LPC-16: 0. CONCLUSIONS Our data demonstrate that the PPOS protocol increases the levels of 12 lipids in FF, which reveals a strong association between the differentially elevated lipids and better IVF/ICSI outcomes.

Predictive factors for oocyte retrieval failure in controlled ovarian hyperstimulation protocols: a retrospective observational cohort study

BACKGROUND

Oocyte retrieval failure following an ovarian hyperstimulation protocol is uncommon in assisted reproductive technology (ART) programs. We analyzed the predictive factors for oocyte retrieval failure following controlled ovarian hyperstimulation (COH) with gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols in ART programs.

METHODS

This study was a retrospective cohort observational study. In total, 744 cycles from 361 patients who underwent controlled ovarian hyperstimulation with GnRH agonist long protocol or antagonist protocol were analyzed. Treatment cycles with oocyte retrieval failure and with one or more oocytes retrieved were compared to determine predictive factors for oocyte retrieval failure using univariate and multilevel multivariate logistic regression analyses.

RESULTS

Oocyte retrieval failure occurred in 38 cycles (5.1%). The oocyte retrieval failure rate of the GnRH antagonist protocol (8.1%) was significantly higher than that of the GnRH agonist long protocol (3.7%). On multilevel multivariate logistic analysis, cycles with GnRH antagonist protocol (odds ratio [OR] 3.06, 95% confidence interval [CI] 1.05-8.96), estradiol level on the day of human chorionic gonadotropin (hCG) injection (OR 0.997, 95% CI 0.996-0.998), and luteinizing hormone (LH) level on the day of hCG injection (OR 1.19, 95% CI 1.06-1.33) were independent predictive factors for oocyte retrieval failure. The efficacy of estradiol and LH levels on the day of hCG injection for predicting oocyte retrieval failure was evaluated using receiver operating characteristic curves. In all cycles, the areas under the curve (AUCs) for estradiol and LH were 0.84 and 0.63, respectively, for all cycles; 0.84 and 0.52, respectively, for cycles with GnRH agonist long protocol; and 0.81 and 0.82, respectively, for cycles with GnRH antagonist protocol.

CONCLUSIONS

Our results suggest that in cycles with GnRH antagonist protocol, the levels of estradiol and LH on the day of hCG injection might be predictive factors for oocyte retrieval failure. This relationship may provide useful information to both patients and physicians for developing better COH protocols in ART programs.