ELEVATED LUTEINIZING-HORMONE ON THE DAY OF HUMAN CHORIONIC-GONADOTROPIN ADMINISTRATION DOES NOT REDUCE CYCLE FECUNDITY IN A LOW-DOSE FLARE-UP IN-VITRO FERTILIZATION PROTOCOL

Objective: To determine if elevated LH at the time of hCG administrati on occurs and adversely affects success in a low-dose gonadotropin-rel easing hormone analogue (GnRH-a) flare-up protocol in hMG-stimulated I VF cycles. Design: Pearson correlation matrix analysis of hormonal, ga mete, and clinical data derived from 203 consecutive IVF cycles was pe rformed. All patients were treated with low-dose GnRH-a (250 mu g SC l euprolide acetate) and hMG. In 203 consecutive IVF cases, serum was ob tained on the day of hCG administration and assayed for E(2), LH, and P. These data were correlated with peak E(2), number of follicles, ooc ytes, embryos, and conceptions. Additionally, patients with elevated L H were compared with the nonelevated LH group. Results: Twenty six wom en had LH > 35 mIU/mL (mean +/- SEM; 51.1 +/- 1.9) and five pregnancie s (cycle fecundity 19.2% per retrieval). One hundred seventy seven pat ients had LH < 35 mIU/mL (16.3 +/- 0.5) and 25 pregnancies (cycle fecu ndity 14.1%). There were no differences in the mean P (1.0 +/- 0.1 ng/ mL, conversion factor to SI unit, 3.81) and E(2) (1,672 +/- 144 pg/mL, conversion factor to SI unit, 3.671) of the former group compared wit h the P (1.1 +/- 0.07 ng/mL) and E(2) (1,456 +/- 69 pg/mL) of the latt er group. There was no correlation with the number of follicles, oocyt es, embryos, pregnancies, E(2), or P to LH concentration (r((max)) = 0 .132). Conclusion: In a low-dose, GnRH-suppression, IVF induction prot ocol, elevated LH occurs in a small subset (13%) of women at the time of hCG administration. This event does not appear to alter cycle fecun dity nor induce premature luteinization.