Yüksek bazal LH seviyeleri daha iyi yardımcı üreme siklus sonuçları ile ilişkilidir

Öz

Amaç: Gonadotropin stimülasyonuna over yanıtını değerlendirmek için birçok parametre bulunmaktadır. Basal LH seviyeleri FSH seviyelerine ek olarak over yanıtında önerilmektedir. Bu çalışma ile GnRH-antagonist IVF (in-vitro fertilizasyon) siklusu uygulanan hastalarda bazal LH seviyelerinin siklus ve gebelik sonuçları ile ilişkisini değerlendirmek amaçlanmıştır.
Yöntemler: Retrospektif kohort çalışmaya FSH değeri 10 IU/L’den daha düşük olan 317 siklus dahil edilmiştir. Bazal hormonal bulgular (FSH, LH, estradiol) ovaryan stimülasyon başlamadan önce kaydedildi. Hastalara GnRH-antagonist protokol ve rekombinant FSH tedavisi uygulandı. Hastalar; LH değeri için belirlenmiş olan eşik değerlere göre kategorize edilmişlerdir (Grup 1: LH <4,1 IU/L ve Grup 2: LH 4,1). Elde edilen toplam oosit sayısı, matür oosit sayısı, implantasyon oranı, klinik gebelik ve devam eden gebelik oranı çalışma grupları arasında analiz edilerek karşılaştırıldı.
Bulgular: Grup 2 hastalarda, Grup 1 ile karşılaştırıldığında daha fazla oosit sayısı ve matür oosit sayısı tespit edilmiştir (P=0,006 ve P=0,03). İstatistiksel olarak anlamlı olmasa dahi, yüksek LH seviyelerinde daha yüksek gebelik oranları lehine bir eğilim saptandı. Klinik gebelik ve devam eden gebelik oranları Grup 1’de daha düşüktü ancak bu farklılık istatistiksel olarak anlamlı değildi (Klinik ve devam eden gebelik için sırasıyla %38,3’e karşı %48,5, P=0,162 ve %29,4’e karşı %34,0, P=0,535). Bazal LH seviyeleri oosit sayısı ile pozitif olarak korele olarak saptandı ve düşük FSH seviyeleri ile kombinasyonu da daha fazla oosit sayısı ve pik östrojen düzeyleri ile ilişkili bulundu.
Sonuç: Artmış bazal LH seviyeleri toplam elde edilen oosit sayısı gibi siklus sonuçları üzerinde faydalı etki sağlayabilir. Bununla birlikte klinik gebelik oranları LH seviyesi eşik değerinin altında ve üstünde olanlar arasında benzer olarak tespit edildi.

Anahtar Kelimeler

• Luteinize edici hormon,IVF (in-vitro fertilizasyon),İnfertilite,Oosit sayısı,Gebelik oranı

High basal LH levels are associated with improved cycle outcomes of assisted reproduction

Abstract

Aim: Several parameters are used to observe the ovarian responsiveness to gonadotropin stimulation. Basal LH levels have been suggested on ovarian response as well as basal FSH levels. This study was aimed to evaluate the correlation of basal LH levels with cycle and pregnancy outcomes in patients who underwent GnRH-antagonist IVF (in-vitro fertilization) cycles.

Methods: This retrospective cohort study recruited a total of 317 cycles with values of FSH <10 IU/L. Basal hormonal parameters (FSH, LH, estradiol) were recorded prior to ovarian stimulation. Patients were treated with GnRH antagonist protocols and stimulated with recombinant FSH. The patients were categorized according to designated threshold levels for LH values (Group 1: LH <4.1 IU/L and Group 2: LH 4.1). The number of total retrieved oocytes and mature oocytes, implantation rate, clinical pregnancy rate and ongoing pregnancy rate were analyzed between study groups. 

Results: Group 2 had a higher number of retrieved oocytes and mature oocytes compared to Group 1 (P=0.006 and P=0.03, respectively). Although not statistically significant, there was a trend towards higher rates of pregnancy on high LH levels. Clinical and ongoing pregnancy rates were insignificantly lower in Group 1 (38.3% vs. 48.5%, P=0.162 and 29.4% vs. 34.0%, P=0.535; respectively). The basal LH levels positively correlated with the number of oocytes, and the combination with low FSH levels was also found to be associated with higher number of retrieved oocytes and peak estradiol levels. 

Conclusions: Elevated basal LH levels provide a beneficial effect on cycle outcome such as number of retrieved oocytes. However, clinical pregnancy rates were found to be similar between below and above the threshold of LH levels.

Keywords

• Luteinizing hormone,IVF (in-vitro fertilization),Infertility,Oocyte number,Pregnancy rate

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