title: Low-dose human chorionic gonadotropin may improve in vitro fertilization cycle outcomes in patients with low luteinizing hormone levels after gonadotropin-releasing hormone antagonist administration.
abstract: OBJECTIVE
  To evaluate the effect of low levels of endogenous luteinizing hormone (LH) and low-dose human chorionic gonadotropin (hCG) supplementation on in vitro fertilization (IVF) cycle outcomes in a gonadotropin-releasing hormone (GnRH) antagonist protocol.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Military medical center.
  
  
  METHODS
  General in vitro fertilization/embryo transfer (IVF-ET) population.
  
  
  METHODS
  Addition of low-dose urinary hCG to IVF stimulations using a recombinant follicle-stimulating hormone (FSH) and GnRH antagonist protocol.
  
  
  METHODS
  Implantation and live-birth rates.
  
  
  RESULTS
  As part of a larger cohort of 239 patients, 42 patients with LH levels ≤ 0.5 mIU/mL were evaluated. In the larger cohort, there were no differences in implantation and pregnancy rates between the recombinant FSH only (n = 113) and the recombinant FSH with low-dose hCG supplementation (n = 126) groups. In the FSH-only group, patients with LH levels ≤ 0.5 mIU/mL had decreased implantation rates (19% vs. 42%) and live-birth rates (25% vs. 54%) as compared with patients with LH levels >0.5 mIU/mL. Low LH patients in the recombinant FSH with low-dose urinary hCG group had statistically significantly higher implantation rates (54% vs. 19%) and live-birth rates (64% vs. 25%) as compared with patients with similar low LH levels in the recombinant FSH-only group.
  
  
  CONCLUSIONS
  Endogenous LH levels ≤ 0.5 mIU/mL after GnRH antagonist treatment are associated with statistically significantly lower implantation and pregnancy rates in recombinant FSH-only cycles. The addition of low-dose urinary hCG results in improved implantation and live-birth rates in patients with low LH levels.
authors.affiliation: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA. anthony.propst@usuhs.mil
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Propst
authors.forename: Micah J
authors.initials: MJ
authors.lastname: Hill
authors.forename: Gordon Wright
authors.initials: GW
authors.lastname: Bates
authors.forename: Michelle
authors.initials: M
authors.lastname: Palumbo
authors.forename: Anne K
authors.initials: AK
authors.lastname: Van Horne
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Retzloff
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000639:trends*; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin; D006727:Hormone Antagonists; D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone