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...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2020-01-01
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| Series: | Journal of Human Reproductive Sciences |
| Subjects: | |
| Online Access: | http://www.jhrsonline.org/article.asp?issn=0974-1208;year=2020;volume=13;issue=3;spage=191;epage=195;aulast=Kochhar |
| _version_ | 1819092159843794944 |
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| author | Puneet Kaur Kochhar Pranay Ghosh |
| author_facet | Puneet Kaur Kochhar Pranay Ghosh |
| author_sort | Puneet Kaur Kochhar |
| collection | DOAJ |
| description | 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 E2and 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. |
| first_indexed | 2024-12-21T22:51:11Z |
| format | Article |
| id | doaj.art-cdf792801fca4e73960beebf296d19ec |
| institution | Directory Open Access Journal |
| issn | 0974-1208 1998-4766 |
| language | English |
| last_indexed | 2024-12-21T22:51:11Z |
| publishDate | 2020-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Human Reproductive Sciences |
| spelling | doaj.art-cdf792801fca4e73960beebf296d19ec2022-12-21T18:47:35ZengWolters Kluwer Medknow PublicationsJournal of Human Reproductive Sciences0974-12081998-47662020-01-0113319119510.4103/jhrs.JHRS_133_19Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilizationPuneet Kaur KochharPranay GhoshContext/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 E2and 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.http://www.jhrsonline.org/article.asp?issn=0974-1208;year=2020;volume=13;issue=3;spage=191;epage=195;aulast=Kochharcycle cancelationgonadotropin-releasing hormone antagonist in vitro fertilizationpremature luteinizationpremature luteinizing hormone surge |
| spellingShingle | Puneet Kaur Kochhar Pranay Ghosh Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization Journal of Human Reproductive Sciences cycle cancelation gonadotropin-releasing hormone antagonist in vitro fertilization premature luteinization premature luteinizing hormone surge |
| title | Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization |
| title_full | Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization |
| title_fullStr | Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization |
| title_full_unstemmed | Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization |
| title_short | Diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin-releasing hormone antagonist cycles in In vitro fertilization |
| title_sort | diminished ovarian reserve predisposes to premature luteinizing hormone surges in gonadotropin releasing hormone antagonist cycles in in vitro fertilization |
| topic | cycle cancelation gonadotropin-releasing hormone antagonist in vitro fertilization premature luteinization premature luteinizing hormone surge |
| url | http://www.jhrsonline.org/article.asp?issn=0974-1208;year=2020;volume=13;issue=3;spage=191;epage=195;aulast=Kochhar |
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