Effects Of Luteinizing Hormone Supplementation On Outcomes Of In Vitro Fertilization And Embryo Transfer In Advanced Age Women Undergoing GnRH-agonist Long Protocol

ObjectiveIn this study,we selected advanced age women（age≥35 years old）in different conditions receiving luteinizing hormone supplementation undergoing GnRH-agonist long protocol assisted by in vitro fertilization and embryo transfer（IVF-ET）to compare the clinical outcomes.MethodSelected from January 2015 to April 2019 referred to the Reproductive Center of the Third Affiliated Hospital of Guangzhou Medical University,1051 advanced age female patients（1051 cycles）received GnRH-a long protocol treatment.It is divided into two groups according to whether luteinizing hormone supplementation is received in the process of ovarian stimulation,group I（n=333）is the non-addition group and group II（n=718）is the addition group.GroupⅡwere divided into three subgroups for comparison according to their different luteinizing hormone supplementation during treatment:group 1（n=323）added with follicle stimulating hormone（FSH）and human menopausal gonadotropin（HMG）,group 2（n=222）added with FSH and recombinant luteinizing hormone（r-LH）,group 3（n=173）added with FSH,HMG and r-LH.Finally we compared the clinical data,laboratory results and clinical pregnancy outcomes of each group.ResultA comparison revealed that between group I and group II there was no statistical difference in age,body mass index,base estrodial（b E2）,base follicular stimulating hormone/base luteinizing hormone（bFSH/bLH）,anti-Müllerian hormone（AMH）（P>0.05）.The LH value on the 7th day of ovarian stimulation in group I was significantly higher than that in group II（P<0.05）.The results of ovarian stimulation showed that group II had more Gn days and total Gn dosage than group I（P<0.05）,while in group II subgroups,the Gn days and Gn dosage of group 2 were less than those of group 1 and 3（P<0.05）.The LH value on HCG administration day in group II was significantly lower than that in group I（P<0.05）.There was no statistical difference between group I and group II in the endometrial thickness on HCG administration day and the E₂ level on HCG administration day（P>0.05）.The number of oocytes in group I were higher than those in group II（P<0.05）.There was no statistical difference in the available embryo rate between the two groups（P>0.05）.The E2 level on HCG administration day of group 3 was significantly lower than that of group 2（P<0.05）but there was no statistical difference with group1（P>0.05）,and there was no statistical difference of the E₂ level on HCG administration day between Group 1 and 2（P>0.05）.The available embryo rate of the 2 groups was significantly higher than that of the 1 group（P<0.05）,but there was not statistically difference between group 1 and group 2（P>0.05）.There was no statistical difference in available embryo rate between group 1 and group 3（P>0.05）.There was no statistical difference in the number of oocytes obtained and the endometrial thickness on HCG administration day among the subgroups（P>0.05）.Comparison of clinical pregnancy outcomes between the two groups:There was no statistical difference in clinical pregnancy rate,live birth rate and miscarriage rate between group I and group II,and there were no significant differences among its subgroups（P>0.05）.ConclusionThe luteinizing hormone supplementation to advanced age women with lower LH undergoing GnRH-agonist long protocol may make the clinical pregnancy outcomes similar with normal advanced age women.Adopting r-LH as luteinizing hormone supplementation scheme may shorten the ovulation stimulation time and dose,increase the available embryo rate.