Defining the "sweet spot" for administered luteinizing hormone-to-follicle-stimulating hormone gonadotropin ratios during ovarian stimulation to protect against a clinically significant late follicular increase in progesterone: an analysis of 10,280 first in vitro fertilization cycles

作者：Werner Marie D^*; Forman Eric J; Hong Kathleen H; Franasiak Jason M; Molinaro Thomas A; Scott Richard T Jr

来源：Fertility and Sterility, 2014, 102(5): 1312-1317.

DOI：10.1016/j.fertnstert.2014.07.766

• Gonadotropins
• late follicular increase in progesterone
• exogenous LH
• exogenous FSH
• stimulation

Objective: To determine whether different ratios of administered LH-to-FSH influence the risk of clinically relevant late follicular P elevations and whether there is an optimal range of LH-to-FSH to mitigate this risk.
Design: Retrospective cohort.
Setting: Private academic center.
Patient(s): A total of 10,280 patients undergoing their first IVF cycle.
Intervention(s): None.
Main Outcome Measure(s): The ratio of exogenous LH-to-FSH throughout stimulation and association with absolute serum P level >= 1.5 ng/mL on the day of hCG administration.
Result(s): Stimulations using no administered LH (N = 718) had the highest risk of P elevation >= 1.5 ng/mL (relative risk [RR] = 2.0; 95% confidence interval [CI] 1.8-2.2). The lowest risk of P increase occurred with an LH-to-FSH ratio of 0.30: 0.60 (20%; N = 4,732). In contrast, ratios < 0.30, reflecting proportionally less administered LH (N = 4,847) were at increased risk for premature P elevation (32%, RR = 1.6; 95% CI 1.5-1.7) as were ratios >0.60 (23%, RR 1.1; 95% CI 1.0-1.3). This pattern of lowest risk in the 0.30-0.60 range held true for cycles characterized by low, normal, and high response. When performing a logistic regression to control for multiple confounding variables this relationship persisted.
Conclusion(s): Absent or inadequate LH dosing is associated with a risk for a late follicular elevation in P sufficient to induce suboptimal outcomes. A total LH-to-FSH ratio of 0.30: 0.60 was associated with the lowest risk of P elevation. Optimization of this parameter should be considered when making gonadotropin dosing decisions.

• 出版日期2014-11
• 单位rutgers