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Fertil Steril. 2014 Nov;102(5):1312-7. doi: 10.1016/j.fertnstert.2014.07.766. Epub 2014 Aug 20.

Defining the "sweet spot" for administered luteinizing hormone-to-follicle-stimulating hormone gonadotropin ratios during ovarian stimulation to protect against a clinically significant late follicular increase in progesterone: an analysis of 10,280 first in vitro fertilization cycles.

Author information

1
Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey. Electronic address: mwerner@rmanj.com.
2
Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Reproductive Medicine Associates of New Jersey, Basking Ridge, New Jersey.
3
Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.

Abstract

OBJECTIVE:

To determine whether different ratios of administered LH-to-FSH influence the risk of clinically relevant late follicular P elevations and whether there is an optimal range of LH-to-FSH to mitigate this risk.

DESIGN:

Retrospective cohort.

SETTING:

Private academic center.

PATIENT(S):

A total of 10,280 patients undergoing their first IVF cycle.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

The ratio of exogenous LH-to-FSH throughout stimulation and association with absolute serum P level≥1.5 ng/mL on the day of hCG administration.

RESULT(S):

Stimulations using no administered LH (N=718) had the highest risk of P elevation≥1.5 ng/mL (relative risk [RR]=2.0; 95% confidence interval [CI] 1.8-2.2). The lowest risk of P increase occurred with an LH-to-FSH ratio of 0.30:0.60 (20%; N=4,732). In contrast, ratios<0.30, reflecting proportionally less administered LH (N=4,847) were at increased risk for premature P elevation (32%, RR=1.6; 95% CI 1.5-1.7) as were ratios>0.60 (23%, RR 1.1; 95% CI 1.0-1.3). This pattern of lowest risk in the 0.30-0.60 range held true for cycles characterized by low, normal, and high response. When performing a logistic regression to control for multiple confounding variables this relationship persisted.

CONCLUSION(S):

Absent or inadequate LH dosing is associated with a risk for a late follicular elevation in P sufficient to induce suboptimal outcomes. A total LH-to-FSH ratio of 0.30:0.60 was associated with the lowest risk of P elevation. Optimization of this parameter should be considered when making gonadotropin dosing decisions.

KEYWORDS:

Gonadotropins; exogenous FSH; exogenous LH; late follicular increase in progesterone; stimulation

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