Is a premature rise in luteinizing hormone in the absence of increased progesterone levels detrimental to pregnancy outcome in GnRH antagonist in vitro fertilization cycles

Objective: To determine whether a premature rise in the level of luteinizing hormone (LH) without a concomitant increase in the level of progesterone is detrimental to pregnancy outcome in flexible gonadotropin-releasing hormone (GnRH) antagonist in vitro fertilization (IVF) cycles. Design: Retrospective cohort study. Setting: Large academic IVF practice. Patient(s): All women undergoing their first GnRH-antagonist in vitro fertilization cycle at the University of Pittsburgh Medical Center between January 1, 2007, and October 1, 2010. Intervention(s): None. Main Outcome Measure(s): Primary outcome measures included the overall pregnancy rate, live-birth/ongoing pregnancy rate, and early pregnancy loss compared between cycles with and without a premature rise in the LH level; secondary outcome measures included the number of oocytes retrieved and embryos obtained during the cycle. Result(s): Overall, 451cycles were included in the analysis. Patients who experienced a premature rise in LH had improved ovarian reserve parameters and had more oocytes retrieved compared with patients who did not experience an LH rise. However, the premature rise in LH was associated with a decreased ongoing pregnancy rate despite these improvements in cycle parameters. Conclusion(s): The incidence of premature LH rise without a concomitant progesterone increase is more common than previously reported and is associated with decreased rates of ongoing pregnancy. (Fertil Steril (R) 2011;96:585-9. (C) 2011 by American Society for Reproductive Medicine.)