Serum LH Levels on hCG Trigger Day Affect IVF Outcomes Intensified by Poor Ovarian Reserve and Advanced Age

Abstract

Abstract Objective To assess the impact of luteinizing hormone (LH) level of hCG trigger day on in-vitro fertilization (IVF) outcomes after fresh embryo transfers, and whether the effects are associated with women’ ovarian reserve and age. Methods Totally 1,423 women who underwent GnRH antagonist protocol for controlled ovarian stimulation at their first IVF cycle were included and stratified by LH level on hCG trigger day, 0.86 IU/L(10th ), 1.3 IU/L (25th ), 1.94 IU/L (50th ), 3.07 IU/L (75th ), 4.75 IU/L (90th ). Results LH level among 1.3-<1.94 IU/L presented the highest live birth rate (LBR, 52.3%) and lowest early pregnancy loss rate (ePLR, 10.5%), while LH < 0.86 IU/L had the lowest LBR (40.4%) and highest ePLR (15.6%). We further stratified the population into three groups, low LH (< 1.3 IU/L), normal LH (1.3-<4.75 IU/L) and high LH (≥ 4.75 IU/L). Multivariate regression analysis indicated that low LH was associated with lower chances of LBR (Adjusted odds ratio (AOR) 0.66, 95% CI 0.51 to 0.85), combined with increased risks of ePLR (AOR 1.51, 1.06 to 2.15). Additionally, the absolute risk difference for LBR was up to -16.3% between low LH and normal LH group among the poor ovarian reserve (AMH < 1.2 ng/ml), much greater than that among normal ovarian reserve (-10.0%). The same trend was showed in women ≥ 35 years age. Conclusions Either declined or elevated LH levels on hCG day were associated with adverse IVF outcomes. Compared with normal LH, low LH decreased the LBR and increased the ePLR, and the effects were exacerbated by poor ovarian reserve and advanced age.