Retrospective evaluation of the impact of basal luteinizing hormone levels on in-vitro fertilization outcomes in patients treated with Gnrh antagonist protocol

ABSTRACT Artıran n., Retrospective Evaluation of the Impact of Basal Luteinizing Hormone Levels on In-Vitro Fertilization Outcomes in Patients Treated with GnRH Antagonist Protocol, Hacettepe University Faculty of Medicine, Department of Gynecology and Obstetrics, Ankara, 2023. This thesis study investigates the impact of LH values measured during the early follicular phase on IVF success. A retrospective analysis was performed on patients who underwent treatment at the Hacettepe University Hospital IVF Centre between January 2014 and December 2022. The study included patients who underwent pituitary suppression using the antagonist protocol and hCG for ovulation triggering. Initial transvaginal ultrasound revealed a total antral follicle count of >4 on the third day of their menstrual cycle. The study included patients aged 15 to 45 with a body mass index (BMI) below 35. The analysis involved 312 patients for the FORT assessment. Logistic regression analysis unveiled that each one-unit increase in the baseline LH value had a statistically significant reduction effect on FORT (Odds Ratio [OR]: 0.957, 95% Confidence Interval [CI]: 0.933-0.981, p-value < 0.001). Notably, no statistically significant correlations emerged between patient age, BMI, type of gonadotropin utilized, presence of polycystic ovary syndrome (PCOS), and FORT value (p > 0.05). 100 IU increase in gonadotropin dose was significantly associated with a higher FORT value (OR: 1.021, 95% CI: 1.008-1.035, p-value = 0.002). The FOI analysis included 288 patients. The logistic regression analysis indicated that a one-unit increase in baseline LH value yielded a statistically insignificant decrease in the FOI value (OR: 0.978, 95% CI: 0.951-1.007, p-value = 0.132). For the analysis of oocytes retrieved per aspirated follicle, 259 patients were considered. Logistic regression analysis showed that a one-unit increase in the baseline LH value did not lead to a significant change in the number of collected oocytes per aspirated follicle (OR: 1.010, 95% CI: 0.971-1.050, p-value = 0.627). Maturation rate analysis involved 251 patients. The logistic regression analysis demonstrated that a one-unit increase in the baseline LH value did not result in a significant change in the maturation rate value (OR: 1.011, 95% CI: 0.976-1.048, p-value = 0.541). Fertilization rate analysis excluded male factor patients, evaluating 229 patients. The logistic regression analysis revealed that a one-unit increase in the baseline LH value did not cause a significant change in the fertilization rate value (OR: 1.001, 95% CI: 0.965-1.038, p-value = 0.971). Blastulation rate analysis excluded third-day embryo transfers and third-day embryo-freezing patients, encompassing 135 patients. The analysis indicated that a one-unit increase in the baseline LH value did not lead to a significant change in the blastulation rate value (OR: 1.008, 95% CI: 0.961-1.058, p-value = 0.735). When percentile analysis is performed according to LH values, it was observed that there was no difference in terms of pregnancy results obtained with fresh transfer (beta hCG positivity, clinical pregnancy, abortion, biochemical pregnancy, live birth) (p > 0.05).Overall, our findings suggest that higher baseline LH values were associated with a significant decrease in patients' FORT values, indicating a weaker response to ovarian stimulation compared to patients with lower LH levels. However, it was observed that this change in basal LH values did not have a direct effect on oocyte maturation, fertilization, blastulation, or pregnancy outcomes. Key words: Luteinizing hormone, pituitary suppression, follicular output rate, follicle oocyte index, maturation rate, fertilization rate, blastulation rate