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Background <p>The clinical implications of elevated luteinizing hormone (LH) levels in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo transfer cycles remain unclear, particularly regarding oocyte maturation and pregnancy outcomes. We aimed to evaluate the impact of basal LH elevation on treatment outcomes and compare the efficacy of protocols involving gonadotropin-releasing hormone antagonist (GnRH-ant) and gonadotropin-releasing hormone agonist (GnRH-a) for ovarian stimulation in patients with PCOS undergoing in vivo IVF/ICSI.</p> Methods <p>This single-center, retrospective cohort study included 1,269 patients with PCOS who underwent IVF/ICSI treatment following a flexible GnRH-ant or long GnRH-a protocol with a human chorionic gonadotropin trigger between January 2013 and December 2023. Primary outcomes included the number of retrieved oocytes, metaphase II (MII) oocytes, two pronuclear embryos, high-quality embryos, and the ovarian hyperstimulation syndrome (OHSS) rate. Secondary outcomes included clinical pregnancy, miscarriage, and live birth rates following fresh embryo transfer.</p> Results <p>Among the participants, 492 (38.77%) exhibited basal LH levels of ≥ 10 mIU/mL, and 777 (61.23%) had LH levels of &lt; 10 mIU/mL. Additionally, 465 (36.64%) and 804 (63.36%) participants underwent GnRH-ant and GnRH-a protocols, respectively. Elevated basal LH levels showed no significant associations with MII oocyte yield, fertilization rate, high-quality embryo count, or clinical pregnancy outcomes (all <i>p</i> &gt; 0.05). However, patients with high LH levels demonstrated increased oocyte retrieval (<i>p</i> = 0.008), a high incidence of ovarian hyperstimulation syndrome (OHSS) (<i>p</i> &lt; 0.001), and reduced fresh embryo transfer rates (<i>p</i> = 0.003). The GnRH-ant protocol required shorter stimulation duration (<i>p</i> &lt; 0.001) and lower amounts of recombinant follicle-stimulating hormone (<i>p</i> &lt; 0.001) than did the GnRH-a protocol. The GnRH-ant protocol also yielded significantly higher proportions of oocytes (<i>p</i> = 0.022), MII oocytes (<i>p</i> = 0.003), and high-quality embryos (<i>p</i> &lt; 0.001); however, it exhibited lower fresh embryo transfer rates (<i>p</i> &lt; 0.001). The two protocols showed no significant differences concerning clinical pregnancy success or OHSS risk.</p> Conclusions <p>Elevated basal LH levels did not impair the outcome of fresh embryo transfer in women with PCOS undergoing IVF/ICSI. However, the number of retrieved oocytes and the OHSS rate were significantly higher in patients with high basal LH levels. The GnRH-ant protocol is an efficient alternative for this subpopulation, particularly regarding stimulation efficiency.</p> Clinical trial number <p>Not applicable.</p>

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Effects of high basal luteinizing hormone levels on in vitro fertilization/intra-cytoplasmic injection outcomes in polycystic ovarian syndrome: a retrospective study

  • 期刊论文

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  • 发表日期：

    2025年12月24日

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  • Hongfa Peng,
  • Lu Wang,
  • Jingjing Jiang,
  • Ting Pan,
  • Yang Yang,
  • Na Cui,
  • Yanan Sun,
  • Guimin Hao,
  • Wei Wang

摘要

Background

The clinical implications of elevated luteinizing hormone (LH) levels in patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) fresh embryo transfer cycles remain unclear, particularly regarding oocyte maturation and pregnancy outcomes. We aimed to evaluate the impact of basal LH elevation on treatment outcomes and compare the efficacy of protocols involving gonadotropin-releasing hormone antagonist (GnRH-ant) and gonadotropin-releasing hormone agonist (GnRH-a) for ovarian stimulation in patients with PCOS undergoing in vivo IVF/ICSI.

Methods

This single-center, retrospective cohort study included 1,269 patients with PCOS who underwent IVF/ICSI treatment following a flexible GnRH-ant or long GnRH-a protocol with a human chorionic gonadotropin trigger between January 2013 and December 2023. Primary outcomes included the number of retrieved oocytes, metaphase II (MII) oocytes, two pronuclear embryos, high-quality embryos, and the ovarian hyperstimulation syndrome (OHSS) rate. Secondary outcomes included clinical pregnancy, miscarriage, and live birth rates following fresh embryo transfer.

Results

Among the participants, 492 (38.77%) exhibited basal LH levels of ≥ 10 mIU/mL, and 777 (61.23%) had LH levels of < 10 mIU/mL. Additionally, 465 (36.64%) and 804 (63.36%) participants underwent GnRH-ant and GnRH-a protocols, respectively. Elevated basal LH levels showed no significant associations with MII oocyte yield, fertilization rate, high-quality embryo count, or clinical pregnancy outcomes (all p > 0.05). However, patients with high LH levels demonstrated increased oocyte retrieval (p = 0.008), a high incidence of ovarian hyperstimulation syndrome (OHSS) (p < 0.001), and reduced fresh embryo transfer rates (p = 0.003). The GnRH-ant protocol required shorter stimulation duration (p < 0.001) and lower amounts of recombinant follicle-stimulating hormone (p < 0.001) than did the GnRH-a protocol. The GnRH-ant protocol also yielded significantly higher proportions of oocytes (p = 0.022), MII oocytes (p = 0.003), and high-quality embryos (p < 0.001); however, it exhibited lower fresh embryo transfer rates (p < 0.001). The two protocols showed no significant differences concerning clinical pregnancy success or OHSS risk.

Conclusions

Elevated basal LH levels did not impair the outcome of fresh embryo transfer in women with PCOS undergoing IVF/ICSI. However, the number of retrieved oocytes and the OHSS rate were significantly higher in patients with high basal LH levels. The GnRH-ant protocol is an efficient alternative for this subpopulation, particularly regarding stimulation efficiency.

Clinical trial number

Not applicable.