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Increased risk of early pregnancy loss by profound suppression of luteinizing hormone during ovarian stimulation in normogonadotrophic women undergoing assisted reproduction
Abstract
The impact of suppressed concentrations of circulating luteinizing hormone (LH) during ovarian stimulation on the outcome of in-vitro fertilization or intracytoplasmic sperm injection treatment in 200 consecutive, normogonadotrophic women (couples) was analysed retrospectively. A standard stimulation protocol with mid-luteal gonadotrophin-releasing hormone (GnRH) agonist down-regulation and ovarian stimulation with recombinant follicle stimulating hormone (FSH) was used in all cases. Blood was sampled from each woman on stimulation days 1 and 8 for analysis of oestradiol and LH in serum. A threshold value of serum LH of 0.5 IU/l on stimulation day 8 (S8) was chosen to discriminate between women with low or 'normal' LH concentrations. Low concentrations of LH on S8 (<0.5 IU/l) were found in 49% (98/200) of the women. This group of women was comparable with the normal LH group with regard to pre-treatment clinical parameters, and to the parameters characterizing the stimulation protocol with the exception of serum oestradiol concentration, which on S8 was significantly lower than in the normal LH group (P < 0.001). The proportion of positive pregnancy tests was similar in the two groups (30% versus 34% per started cycle), but the final clinical treatment outcome was significantly different, with a five-fold higher risk of early pregnancy loss (45% versus 9%; P < 0.005) in the low LH group and consequently a significantly poorer chance of delivery than in the normal LH group. It is concluded that a substantial proportion of normogonadotrophic women treated with GnRH agonist down-regulation in combination with FSH, devoid of LH activity, experience LH suppression, which compromises the treatment outcome. Whether these women would benefit from supplementation with recombinant LH or human menopausal gonadotrophin during ovarian stimulation, remains to be proven in the future by prospective randomized trials.
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“no evidence in the literature directly links hypogonadotropism to delayed parturition and periparturient mortality19–22.”
From Conditional loss of ERK1 and ERK2 results in abnormal placentation and delayed parturition in the mouse (2019) · cites this paper as [20]
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Metadata
- Authors
- Westergaard, L. G.
- Affiliations
- Odense University Hospital (DK)
- Corresponding author
- Westergaard, L. G.
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2000-05-01
- Volume
- 15
- Issue
- 5
- Pages
- 1003-1008
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2131053749
- Cited by
- 301
- References
- 15
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 16 · 2021: 12 · 2020: 3 · 2019: 8 · 2018: 4 · 2017: 8 · 2016: 11 · 2015: 12 · 2014: 12 · 2013: 7 · 2012: 11
- FWCI
- 15.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Biology and Fertility
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Keywords
- luteinizing hormone suppression, early pregnancy loss, ovulation induction, in vitro fertilization, intracytoplasmic sperm injection, GnRH agonist down-regulation, recombinant FSH, estradiol
- MeSH terms
- Abortion, Spontaneous, Adult, Estradiol, Female, Fertilization in Vitro, Follicle Stimulating Hormone, Gonadotropins, Humans, Luteinizing Hormone, Gonadotropin-Releasing Hormone, Luteal Phase, Ovary, Ovulation Induction, Pregnancy, Recombinant Proteins, Reference Values, Retrospective Studies, Treatment Outcome, Sperm Injections, Intracytoplasmic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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