The influence of serum Luteinising hormone concentrations post GnRH agonist trigger on metaphase II oocytes in IVF/ICSI cycles

Background

Gonadotropin releasing hormone agonist (GnRHa) trigger is increasingly used in IVF/ICSI cycles to mitigate the risk of ovarian hyperstimulation syndrome (OHSS), particularly in women with polycystic ovary syndrome (PCOS). While safer than hCG, the endocrine response to GnRHa is highly variable. It has been hypothesised that there exists a threshold serum luteinizing hormone (LH) concentration post trigger that is predictive of optimal oocyte maturation.

However, this threshold has not been clearly established. This study aimed to identify optimum and minimum LH levels measured 12 hours after GnRHa trigger that are predictive of mature oocyte (metaphase II, MII) yield in PCOS patients.

Methods

This prospective, single centre observational study included 104 women with PCOS undergoing controlled ovarian stimulation using a GnRH antagonist protocol. Final oocyte maturation was induced with 2mL Buserelin. Serum luteinising hormone, follicle stimulating hormone (FSH), and progesterone were measured 12 hours post trigger. The primary outcome was correlation between hormone levels and MII oocyte yield. Secondary outcomes included fertilisation and blastocyst conversion. Pearson correlation analysis and receiver operating characteristic (ROC) curves were used to assess the predictive power of hormone levels for oocyte maturity.

Results

The mean LH level at 12 hours post trigger was 34.05 (SD 23.07 IU/L, range: 0.9 to 134.4 IU/L). No statistically significant correlation was found between LH and MII oocyte yield (r = negative 0.123; p = 0.215), fertilisation rate (r = 0.046; p = 0.641), or blastocyst development (r = 0.162; p = 0.101). Similarly, FSH and progesterone showed no significant correlations with primary outcomes. ROC analysis revealed poor predictive capacity of post trigger LH for mature oocyte yield (AUC = 0.402). Notably, patients with 100% MII yield had LH levels as low as 6.8 IU/L, while those with poor MII yield (>0 to 25%) had LH levels as high as 78.9 IU/L, indicating no clear minimum or optimum LH threshold for predicting mature oocyte development.

Conclusion

No specific LH thresholds at 12 hours post GnRHa trigger could be identified as predictive of optimal or suboptimal oocyte maturation. Routine post trigger LH hormone level measurement lacks clinical utility in predicting mature oocyte yield in PCOS IVF/ICSI cycles.