title: Clinical impact of LH rises prior to and during ganirelix treatment started on day 5 or on day 6 of ovarian stimulation.
abstract: BACKGROUND
  We sought to evaluate the incidence and clinical impact of luteinizing hormone (LH) rises prior to and during gonadotropin-releasing hormone (GnRH) antagonist treatment started on day 5 or 6 of ovarian stimulation with recombinant follicle-stimulating hormone (rFSH).
  
  
  METHODS
  Pooled data from three trials with the GnRH antagonist ganirelix started on day 5 (n = 961) and from five trials with ganirelix started on day 6 (n = 1135) of ovarian stimulation with rFSH were retrospectively analyzed.
  
  
  RESULTS
  The incidence of LH rises (LH ≥ 10.0 IU/L) prior to ganirelix treatment was 2.3% and 6.6% on ganirelix start days 5 and 6, respectively (P < 0.01). During ganirelix treatment this incidence was 1.2% and 2.3%, respectively (P = 0.06). Women with LH rise on day 5 or 6 had a higher ovarian response with more oocytes recovered, mean ± SD, 12.9 ± 8.5 versus no LH rise, 10.2 ± 6.4 (P < 0.01). In women with and without LH rise prior to ganirelix treatment the ongoing pregnancy rates were similar (26.0% vs 29.9%; odds ratio [OR], 0.89; 95% confidence interval [CI], 0.55-1.44). Women with LH rise during ganirelix treatment had a lower ovarian response with 7.5 ± 6.7 oocytes recovered versus no LH rise, 10.2 ± 6.4 (P = 0.02) and a tendancy for a lower chance of ongoing pregnancy (16.7% vs 29.9%; OR, 0.52; 95% CI, 0.21-1.26).
  
  
  CONCLUSIONS
  The incidence of early and late LH rises was low but may be further reduced by initiating ganirelix on stimulation day 5 rather than on day 6. In contrast to women with an early LH rise, women with a late LH rise may have a reduced chance of ongoing pregnancy.
authors.affiliation: Advanced Reproductive Medicine & Gynecology of Hawaii, Inc,, 1401 South Beretania St, Honolulu, Hawaii 96814, USA. jfrattarelli@armghawaii.com.
authors.forename: John L
authors.initials: JL
authors.lastname: Frattarelli
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Hillensjö
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Broekmans
authors.forename: Han
authors.initials: H
authors.lastname: Witjes
authors.forename: Jolanda
authors.initials: J
authors.lastname: Elbers
authors.forename: Keith
authors.initials: K
authors.lastname: Gordon
authors.forename: Bernadette
authors.initials: B
authors.lastname: Mannaerts
mesh_terms: D000328:Adult; D005260:Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood*; D016017:Odds Ratio; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; C061018:ganirelix
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