Effect Of Adding Different Types Of Luteinizing Hormone After Down-regulation On In Vitro Fertilization For Patients With Normal Ovarian Function

Objective: To investigate the effects of serum luteinizing hormone(LH)levels on the day of gonadotropins(Gn)initiation,different forms of LH addition and the timing of addition on ovarian response and embryo formation for infertility patients with normal ovarian function who received follicular phase long protocol with long-acting Gn RH agonist.Methods: This retrospective study was performed in the Department of Reproductive Medicine,the Fourth Hospital of Hebei Medical University.Infertility women with normal ovarian function who received follicular phase long protocol with long-acting Gn RH agonist between August 2018 and August 2019 were included.The patients were divided into 2 groups according to serum LH levels on the day of Gn initiation.The patients with serum LH levels higher than 0.7IU/L were assigned to Group A and those with serum LH levels lower than 0.7IU/L were assigned to Group B.The patients in Group A only received urinary FSH for ovarian stimulation.The patients in Group B were divided into 4 subgroups according to different types of Gn for ovarian stimulation,Group B1(urinary FSH),Group B2(urinary FSH and HMG),Group B3(urinary FSH and recombinant LH),Group B4(urinary FSH and HP-HMG).As there is the largest number of patients in Group B3,it was further divided into Group a(adding early)and Group b(adding late)according to the timing of recombinant LH administration.The outcome of each group was compared in terms of total FSH consumption,the days of Gn administration,endometrial thickness,serum estradiol levels,LH levels,progesterone levels on the day of h CG administration,the number of oocytes retrieved,metaphase ?(M?)oocyte rates,fertilization rates,cleavage rates,and high quality embryo rates.Results: 1.In Group A and Group B1,serum LH levels on the day of h CG administration in Group A were higher than those in Group B1(P<0.05).Serum progesterone levels on the day of h CG administration in Group A were lower than those in Group B1(P<0.05).There were no significant difference in terms of total FSH consumption,the days of Gn administration,endometrial thickness,serum estradiol levels on the day of h CG administration of the 2 groups(P>0.05).2.In Group A and Group B1,M oocyte rates in Group A ?were higher than those in Group B1(P<0.05).There were no significant difference in terms of the number of oocytes retrieved,fertilization rates,cleavage rates,and high quality embryo rates of the 2 groups(P>0.05).3.Among the subgroups of Group B,the total FSH consumption in Group B1 was higher than those in Group B2,B3 and B4(P<0.05).Serum LH levels on the day of h CG administration in Group B3 were higher than those in Group B2 and Group B4(P<0.05).Serum progesterone levels on the day of h CG administration in Group B1 were higher than those in Group B3 and Group B4(P<0.05).There were no significant difference among the subgroups of Group B in terms of the days of Gn administration,endometrial thickness,serum estradiol levels on the day of h CG administration(P>0.05).4.Among the subgroups of Group B,the number of oocytes retrieved in Group B3 was lower than that in Group B4(P<0.05).M ?oocyte rates in Group B3 were higher than those in Group B1 and Group B2(P<0.05).The high quality embryo rates in Group B3 were higher than those in Group B4(P<0.05).There were no significant difference among the subgroups of Group B in terms of fertilization rates and cleavage rates(P>0.05).5.In Group a and Group b,the total FSH consumption in Group a was higher than that in Group b(P<0.05).There were no significant difference in terms of the days of Gn administration,endometrial thickness,serum estradiol levels,LH levels,progesterone levels on the day of h CG administration of the 2 groups(P>0.05).6.In Group a and Group b,there were no significant difference in terms of the number of oocytes retrieved,M ?oocyte rates,fertilization rates,cleavage rates,and high quality embryo rates(P>0.05).Conclusions:When serum LH levels were lower than 0.7IU/L after down-regulation with Gn RH agonist on the day of Gn initiation for infertility patients with normal ovarian function:1.Serum LH levels on the day of h CG administration would be lower.Serum progesterone levels on the day of h CG administration would be higher.M? oocyte rates would be lower.2.Adding different forms of LH could reduce total FSH consumption.Adding recombinant LH could keep serum progesterone levels down on the day of h CG administration,improve M? oocyte rates and high quality embryo rates.Adding HP-HMG could keep serum progesterone levels down on the day of h CG administration and improve the number of oocytes retrieved.3.Compared with early follicular phase,adding recombinant LH at mid-to-late follicular phase could reduce total FSH consumption.