Live-birth rates after HP-hMG stimulation in the long GnRH agonist protocol: association with mid-follicular hCG and progesterone concentrations, but not with LH concentrations

Abstract

The aim of this retrospective study was to investigate the impact of endogenous and exogenous luteinizing hormone (LH) activity on treatment outcome, when taking into consideration potential confounding variables. Data were derived from IVF patients (n = 358) stimulated with highly purified menotrophin (HP-hMG) in a long gonadotrophin-releasing hormone (GnRH) agonist protocol. Simple retrospective logistic regression analysis showed that the mid-follicular exogenous concentrations of human chorionic gonadotrophin (hCG) (p = 0.027), provided by the HP-hMG preparation, and female age (p = 0.009) were significantly associated with live-birth rate, while the mid-follicular progesterone concentration (p = 0.075), the estradiol concentration on last stimulation day (p = 0.075) and number of embryos transferred (p = 0.071) were borderline significant. Endogenous LH was not associated with live-birth rate; neither at start of stimulation (p = 0.123), nor in the mid-follicular phase (p = 0.933) or on the last day of stimulation (p = 0.589). In the multiple regression analysis of life birth, mid-follicular hCG (p = 0.016) was identified as a positive predictor, and age (p = 0.004) and mid-follicular progesterone (p = 0.029) as negative predictors. In conclusion, mid-follicular concentrations of exogenous hCG and progesterone, but not endogenous LH, are associated with live-birth rate in IVF patients treated with HP-hMG in a long GnRH agonist cycle.

Figure 1.

Predicted chances of live birth based on a multivariate logistic regression model for patients treated with HP-hMG in a long GnRH agonist protocol. (A) The predicted live-birth rate using the explanatory factors ‘endogenous serum LH concentration’ and ‘exogenous serum hCG concentration on day 6 of stimulation’, where the variables ‘female age’ and ‘progesterone concentration on day 6 of stimulation’ are set to the median values of 31 years and 1.4 nmol/L, respectively. (B) The predicted live-birth rate versus ‘female age’ and ‘exogenous serum hCG concentration on day 6′; concentrations of progesterone and endogenous LH (1.4 IU/L) are set to the median values. (C–E) The predicted live-birth rate versus ‘exogenous serum hCG concentration on day 6′ and ‘serum progesterone concentration on day 6′ for patients aged 26, 31 and 35 years, respectively; the concentration of endogenous LH are set to the median value. The tabulation shows the predicted live-birth rates (and 95% prediction limits) at various female ages and mid-follicular concentrations of hCG and progesterone.