The effect of premature luteinizing hormone increases among high ovarian responders undergoing a gonadotropin‐releasing hormone antagonist ovarian stimulation protocol

Abstract Objective To explore factors causing a premature rise in luteinizing hormone among high ovarian responders undergoing the gonadotropin‐releasing hormone (Gn RH ) antagonist ovarian stimulation protocol. Methods The present retrospective study included healthy women undergoing fresh cycles using a fixed Gn RH antagonist protocol with a predicted high response and antral follicle count ( AFC ) of at least 15 at the Reproductive Medicine Center of Tongji Hospital, China, between January 1 and December 31, 2016. Treatment‐related characteristics, hormone changes, and pregnancy outcomes were compared between patients who did or did not experience a premature luteinizing hormone rise. Results There were 314 patients included; 49 experienced premature luteinizing hormone increases. Among patients who experienced a premature rise in luteinizing hormone, a lower two pronuclear embryo rate ( P =0.038); fewer high‐quality embryos ( P =0.020); higher serum luteinizing hormone ( P =0.006), progesterone ( P =0.013), and estradiol (E2) levels ( P =0.003) on the day of human chorionic gonadotropin administration; a lower clinical pregnancy rate ( P =0.031); and a higher cancellation rate ( P =0.006) were observed. AFC of at least 22 ( P =0.001) and E2 of 669 pg/ mL or higher at the start of Gn RH antagonist administration were predictive of early ( P =0.036) and late ( P =0.033) premature luteinizing hormone increases. Conclusion Earlier administration of Gn RH antagonist could avoid premature luteinizing hormone increases among high ovarian responders, especially those with a starting AFC of 22 or more.