Occult LH Peak in GnRH Antagonist Protocol: A Case Report and Literature Review

doi:10.12280/gjszjk.20220439

Abstract

Abstract:

GnRH antagonist protocol, as a common clinical ovulation protocol, has the advantages of flexibility, economy and safety. However, the early-onset LH peak due to inadequate dosing or inappropriate timing of antagonist addition can ultimately affect pregnancy outcomes. We review the clinical data of a patient who developed an occult LH peak during the antagonist regimen. The patient showed an increased level of progesterone and a decreased level of estradiol during her ovulation with the antagonist regimen, suggesting the occurrence of an occult LH peak. She also had a premature ovulation during the oocyte retrieval procedures. In the second cycle, the long-lasting luteal phase regimen was used to effectively reduce the appearance of endogenous LH peak, and 8 eggs were successfully obtained. We also discuss the diagnosis and prevention of occult LH peak occurring in antagonist regimens in this paper.

Key words: Ovulation induction, Gonadotropin-releasing hormone, Triptorelin pamoate, Luteinizing hormone, Occult LH peak, GnRH antagonist protocol

WANG Ying-xin, ZHANG Ning, XU Shu-ning. Occult LH Peak in GnRH Antagonist Protocol: A Case Report and Literature Review[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(1): 27-30.

Figures/Tables 1

References 21

[1]	Banga FR, Huirne JA, Korsen T, et al. Pituitary sensitizing effect of GnRH antagonists: a mechanism explaining LH escape during IVF?[J]. Hum Reprod, 2010, 25(6):1513-1519. doi: 10.1093/humrep/deq092. doi: 10.1093/humrep/deq092 URL
[2]	Sönmezer M, Pelin Cil A, Atabekoğlu C, et al. Does premature luteinization or early surge of LH impair cycle outcome? Report of two successful outcomes[J]. J Assist Reprod Genet, 2009, 26(2/3):159-163. doi: 10.1007/s10815-009-9299-5. doi: 10.1007/s10815-009-9299-5 URL
[3]	Zhang D, Zhang D, Sun Z, et al. The effect of a transient premature luteinizing hormone surge without elevated serum progesterone on in vitro fertilization outcomes in a gonadotropin-releasing hormone antagonist flexible protocol[J]. Gynecol Endocrinol, 2020, 36(6):550-553. doi: 10.1080/09513590.2019.1683730. doi: 10.1080/09513590.2019.1683730 URL
[4]	姜薇, 季慧, 赵纯, 等. 拮抗剂方案中LH水平对妊娠结局的影响[J]. 中国妇幼健康研究, 2020, 31(11):1573-1577. doi:10.3969/j.issn.1673-5293.2020.011.028. doi: 10.3969/j.issn.1673-5293.2020.011.028
[5]	农璎琦, 阮建兴, 陈烨, 等. 拮抗剂方案中出现早发性黄体生成素峰的处理——病案报道3例[J]. 中华生殖与避孕杂志, 2018, 38(3):244-247. doi: 10.3760/cma.j.issn.2096-2916.2018.03.016. doi: 10.3760/cma.j.issn.2096-2916.2018.03.016
[6]	Dovey S, McIntyre K, Jacobson D, et al. Is a premature rise in luteinizing hormone in the absence of increased progesterone levels detrimental to pregnancy outcome in GnRH antagonist in vitro fertilization cycles[J]. Fertil Steril, 2011, 96(3):585-589. doi: 10.1016/j.fertnstert.2011.06.042. doi: 10.1016/j.fertnstert.2011.06.042 pmid: 21774931
[7]	赵伟娥, 梁晓燕. 不同促性腺激素释放激素类似物对垂体反应性的作用[J]. 生殖医学杂志, 2017, 26(11):1067-1070. doi: 10.3969/j.issn.1004-3845.2017.11.002. doi: 10.3969/j.issn.1004-3845.2017.11.002
[8]	Bosch E, Valencia I, Escudero E, et al. Premature luteinization during gonadotropin-releasing hormone antagonist cycles and its relationship with in vitro fertilization outcome[J]. Fertil Steril, 2003, 80(6):1444-1449. doi: 10.1016/j.fertnstert.2003.07.002. doi: 10.1016/j.fertnstert.2003.07.002 pmid: 14667881
[9]	王凤, 邓伟芬, 杨尚武. 掌握自然周期取得优质卵母细胞时机的探讨[J]. 生殖医学杂志, 2015, 24(10):855-857. doi: 10.3969/j.issn.1004-3845.2015.10.019. doi: 10.3969/j.issn.1004-3845.2015.10.019
[10]	Lu X, Khor S, Zhu Q, et al. Decrease in preovulatory serum estradiol is a valuable marker for predicting premature ovulation in natural/unstimulated in vitro fertilization cycle[J]. J Ovarian Res, 2018, 11(1):96. doi: 10.1186/s13048-018-0469-x. doi: 10.1186/s13048-018-0469-x pmid: 30463583
[11]	洪青青, 陈秋菊, 匡延平. 自然周期紧急取卵在卵巢低反应患者中的应用[J]. 生殖与避孕, 2013, 33(8):541-545. doi: 10.7669/j.issn.0253-357X.2013.08.0541. doi: 10.7669/j.issn.0253-357X.2013.08.0541
[12]	Vicdan K, Akarsu C, Sözen E, et al. Two successful pregnancies achieved by converting an in vitro fertilization cycle to an intrauterine insemination cycle in five cases with documented premature ovulation[J]. J Turk Ger Gynecol Assoc, 2016, 17(4):233-235. doi: 10.5152/jtgga.2016.16118. doi: 10.5152/jtgga.2016.16118
[13]	靳镭, 聂睿. 早发LH峰与“抢收”[J]. 生殖医学杂志, 2010, 19(3):199-204. doi: 10.3969/j.issn.1004-3845.2010.03.011. doi: 10.3969/j.issn.1004-3845.2010.03.011
[14]	何钻玉, 杨冬梓. 进一步认识垂体降调节[J]. 生殖医学杂志, 2013, 22(10):731-736. doi: 10.3969/j.issn.1004-3845.2013.10.001. doi: 10.3969/j.issn.1004-3845.2013.10.001
[15]	王虹. 达菲林治疗子宫内膜异位症临床疗效分析[J]. 当代医学, 2011, 17(18):135-136. doi: 10.3969/j.issn.1009-4393.2011.18.096. doi: 10.3969/j.issn.1009-4393.2011.18.096
[16]	倪亚莉, 刘珍, 柴三明, 等. 1.3mg达菲林降调节在IVF/ICSI中的临床应用[J]. 中国计划生育学杂志, 2006, 14(4):229-231. doi:10.3969/j.issn.1004-8189.2006.04.014. doi: 10.3969/j.issn.1004-8189.2006.04.014
[17]	谭新沙, 雷小敏, 席红琳, 等. 0.94mg注射用醋酸曲普瑞林长方案降调节在IVF-ET中的临床应用[J]. 当代医学, 2013, 19(18):76-77. doi:10.3969/j.issn.1009-4393.2013.18.052. doi: 10.3969/j.issn.1009-4393.2013.18.052
[18]	Kuang Y, Chen Q, Fu Y, et al. Medroxyprogesterone acetate is an effective oral alternative for preventing premature luteinizing hormone surges in women undergoing controlled ovarian hyperstimulation for in vitro fertilization[J]. Fertil Steril, 2015, 104(1):62-70.e3. doi: 10.1016/j.fertnstert.2015.03.022. doi: 10.1016/j.fertnstert.2015.03.022 pmid: 25956370
[19]	白春梅, 苏敏, 王浩原, 等. 卵泡期高孕激素状态下促排卵方案[J]. 中国药物与临床, 2022, 22(3):283-288. doi: 10.11655/zgywylc2022.03.025. doi: 10.11655/zgywylc2022.03.025
[20]	Chen Q, Chai W, Wang Y, et al. Progestin vs. Gonadotropin-Releasing Hormone Antagonist for the Prevention of Premature Luteinizing Hormone Surges in Poor Responders Undergoing in vitro Fertilization Treatment: A Randomized Controlled Trial[J]. Front Endocrinol(Lausanne), 2019, 10:796. doi: 10.3389/fendo.2019.00796. doi: 10.3389/fendo.2019.00796
[21]	冯月枝, 关少艮, 黄永汉. 高孕激素状态下促排卵方案在PCOS患者IVF-ET临床疗效的Meta分析[J]. 生殖医学杂志, 2022, 31(4):482-493. doi:10.3969/j.issn.1004-3845.2022.04.010. doi: 10.3969/j.issn.1004-3845.2022.04.010