The Impact of Serum LH levels on the Day of hCG Trigger on IVF Outcomes in Patients Undergoing GnRH Antagonist Protocols

Optimal hCG day LH levels in antagonist IVF cycles


  • Erhan Demirdağ
  • İsmail Güler Gazi University
  • Cengiz Karakaya Gazi University
  • Esin Şahin Gazi University
  • Münire Funda Cevher Akdulum Gazi University
  • Ahmet Erdem Gazi University
  • Mehmet Erdem Gazi University


Luteinizing Hormone, Fertilization in Vitro, Ovulation Induction, Pregnancy Outcome, Gonadotropin-Releasing Hormone, Hormone Antagonists


Objective: To evaluate whether hCG day serum LH levels have an impact on IVF outcomes in patients undergoing GnRH antagonist protocols.

Methods: This retrospective cohort study was carried out in a private IVF clinic from September 2017 to January 2021. A total of 971 completed IVF cycles with GnRH antagonists were evaluated. Three groups with different LH levels were analysed according to hCG day serum LH concentrations: Group 1: LH ≥10 mIU/ml, Group 2: LH = 1.2-10 mIU/ml, and Group 3: LH <1.2 mIU/ml. 

Results: Total dose of gonadotropin consumption was significantly higher, and the number of MII oocytes retrieved was significantly lower in group 3 than others (p<0.001). The maturation rates and implantation rates were significantly lower in group 3 compared to other groups (p<0.05, p<0.05, respectively). Clinical pregnancy (CPR) and live birth rates (LBR) per cycle were significantly lower in group 3 (6.2%, 6.2%, respectively) compared to group 1 (41.3%, 35.3, respectively) and group 2 (38.7%, 31.4%, respectively) (p<0.001, p<0.001, respectively). CPR and LBR per embryo transfer were also significantly lower in group 3 than others (p=0.003, p=0.029, respectively). Multivariate logistic regression analysis revealed that female age, number of MII oocytes retrieved, and serum hCG day LH levels were the significant variables in predicting live birth. 

Conclusion: Higher hCG day LH levels result in poor pregnancy outcomes, especially in older poor responders, and GnRH antagonists seem ineffective in these patients. However, lower hCG day LH levels may not affect IVF outcomes in antagonist cycles.






Original Research