Iranian Society of Gynecology Oncology

Document Type : Original Research Article


1 Al-Elweyia Maternity Teaching Hospital, Baghdad, Iraq

2 Consultant OBG, Medical College Mustansiriyah University, Baghdad, Iraq

3 F.I.C.M.S, E.B.U, Baghdad, Iraq


Background & Objective: Gonadotropin-releasing hormone acts on the anterior pituitary and promotes the release of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both of great importance in the ovarian cycle.
Materials & Methods: In a prospective cross-sectional study conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies / Al-Nahrain University and Kamal Al-Sameraie Hospital for Infertility and In Vitro Fertilization, Baghdad, Iraq during the period from April 2022 to April 2023, women received rFSH in a single daily dose of (150-300 IU) for ovarian stimulation. Women in groups B and C received ovarian stimulation antagonists, while those in group A did not.
Results: Both clinical and ongoing pregnancy rates were measured for each group. A positive hCG test was found in 27 (79.4%) in Group A while it was positive in 19 (55.9%) in Group B with a significant difference (P=0.03), clinical pregnancy was 25 (73.5%) in Group A while it was positive in 17 (50.0%) in Group B with a significant difference (P=0.04), and ongoing pregnancy was found in 24 (70.6%) in Group A while it was positive in 15 (44.1%) in Group B with significant difference (P=0.01).
Conclusion: Women with LH <4 IU presented with a significantly higher pregnancy rate than those with ≥4 IU, and do not need GnRH antagonist addition as co-treatment.


 Women with LH <4 IU presented with a significantly higher pregnancy rate than those with ≥4 IU, and do not need GnRH antagonist addition as co-treatment.


Main Subjects

1. Zhao S, Xu H, Wu X, Xia L, Li J, Zhang D, et al. The serum follicle stimulating hormone-to-luteinizing hormone ratios can predict assisted reproductive technology outcomes in women undergoing gonadotropin releasing hormone antagonist protocol. Front Endocrinol. 2023;14:1093954. [DOI:10.3389/fendo.2023.1093954] [PMID] [PMCID]
2. Rezaei Z, Taghdisi S. A Comparison of Fertility Rates in Women Undergoing IVF with a Tubal Factor with Surgery, Tubal Factor Infertility Without Surgery, and Unexplained Infertility. J Obstet Gynecol Cancer Res. 2020;5(2):61-7. [DOI:10.30699/jogcr.5.2.61]
3. World Health Organization (WHO). International Classification of Diseases. 2018.
4. Siristatidis CS, Gibreel A, Basios G, Maheshwari A, Bhattacharya S. Gonadotrophin-releasing hormone agonist protocols for pituitary suppression in assisted reproduction. Cochrane Database Syst Rev. 2015(11):Cd006919. [DOI:10.1002/14651858.CD006919.pub4] [PMCID]
5. König TE, van der Houwen LEE, Overbeek A, Hendriks ML, Beutler-Beemsterboer SN, Kuchenbecker WKH, et al. Recombinant LH supplementation to a standard GnRH antagonist protocol in women of 35 years or older undergoing IVF/ICSI: a randomized controlled multicentre study. Hum Reprod. 2013;28(10):2804-12. [DOI:10.1093/humrep/det266] [PMID]
6. Mourad S, Brown J, Farquhar C. Interventions for the prevention of OHSS in ART cycles: an overview of Cochrane reviews. Cochrane Database Syst Rev. 2017;23(1):CD012103. [DOI:10.1002/14651858.CD012103.pub2] [PMID]
7. Liu M, Liu S, Li L, Wang P, Li H, Li Y. LH levels may be used as an indicator for the time of antagonist administration in GnRH antagonist protocols-a proof-of-concept study. Front Endocrinol. 2019;10:67. [DOI:10.3389/fendo.2019.00067] [PMID] [PMCID]
8. Singh R, Kaur S, Yadav S, Bhatia S. Gonadotropins as pharmacological agents in assisted reproductive technology and polycystic ovary syndrome. Trends Endocrinol Metab. 2023;34(4):194-215. [DOI:10.1016/j.tem.2023.02.002] [PMID]
9. Thelmo MC, Acacio BD, Nouriani M. P-149: Peak serum estradiol (E2) is a predictor of pregnancy outcome in in vitro fertilization (IVF). Fertil Steril. 2006;86(3):S187. [DOI:10.1016/j.fertnstert.2006.07.495]
10. Hattori K, Orisaka M, Fukuda S, Tajima K, Yamazaki Y, Mizutani T, et al. Luteinizing Hormone Facilitates Antral Follicular Maturation and Survival via Thecal Paracrine Signaling in Cattle. Endocrinology. 2018;159(6):2337-47. [DOI:10.1210/en.2018-00123] [PMID]
11. Han S, Liu M-h, Lv Y-s, Ren H-y, Guo J, Li Y, et al. Effects of Low Luteinizing Hormone During Ovarian Stimulation on Endometrial Gene Expression and Function-Transcriptome Analysis During the Implantation Window. Reprod Sci. 2022;29(6):1908-20. [DOI:10.1007/s43032-022-00875-5] [PMID]
12. Li Y, Duan Y, Yuan X, Cai B, Xu Y, Yuan Y. A novel nomogram for individualized gonadotropin starting dose in GnRH antagonist protocol. Front Endocrinol. 2021;12:688654. [DOI:10.3389/fendo.2021.688654] [PMID] [PMCID]
13. Depalo R, Trerotoli P, Chincoli A, Vacca MP, Lamanna G, Cicinelli E. Endogenous luteinizing hormone concentration and IVF outcome during ovarian stimulation in fixed versus flexible GnRH antagonist protocols: An RCT. Int J Reprod Biomed. 2018;16(3):175-82. [DOI:10.29252/ijrm.16.3.175] [PMID] [PMCID]
14. Kol S. Individualized treatment from theory to practice: the private case of adding LH during GnRH antagonist-based stimulation protocol. Clin Med Insights Reprod Health. 2014;8:59-64. [DOI:10.4137/CMRH.S17788] [PMID] [PMCID]
15. Raju GA, Chavan R, Deenadayal M, Gunasheela D, Gutgutia R, Haripriya G, et al. Luteinizing hormone and follicle stimulating hormone synergy: A review of role in controlled ovarian hyper-stimulation. J Hum Reprod Sci. 2013;6(4):227-34. [DOI:10.4103/0974-1208.126285] [PMID] [PMCID]
16. Resta C, Moustogiannis A, Chatzinikita E, Ntalianis DM, Ntalianis KM, Philippou A, et al. Gonadotropin-Releasing Hormone (GnRH)/GnRH Receptors and Their Role in the Treatment of Endometriosis. Cureus. 2023;15(4):e38136. [DOI:10.7759/cureus.38136] [PMID] [PMCID]
17. Helmer A, Magaton I, Stalder O, Stute P, Surbek D, von Wolff M. Optimal Timing of Ovulation Triggering to Achieve Highest Success Rates in Natural Cycles-An Analysis Based on Follicle Size and Oestradiol Concentration in Natural Cycle IVF. Front Endocrinol. 2022;13:855131. [DOI:10.3389/fendo.2022.855131] [PMID] [PMCID]
18. Chen C-D, Chiang Y-T, Yang P-K, Chen M-J, Chang C-H, Yang Y-S, et al. Frequency of low serum LH is associated with increased early pregnancy loss in IVF/ICSI cycles. Reprod Biomed Online. 2016;33(4):449-57. [DOI:10.1016/j.rbmo.2016.07.001] [PMID]
19. Liu S, Lv Y-s, Han S, Liu M, Ma S, Ren H, et al. A novel GnRH antagonist protocol based on LH levels versus traditional flexible GnRH antagonist protocol in PCOS patients undergoing in vitro fertilization: study protocol for a randomized controlled, non-inferiority trial. Trials. 2022;23(1):654. [DOI:10.1186/s13063-022-06586-1] [PMID] [PMCID]
20. Zhang Y, Zhao W, Han Y, Chen X, Xu S, Hu Y, et al. The follicular-phase depot GnRH agonist protocol results in a higher live birth rate without discernible differences in luteal function and child health versus the daily mid-luteal GnRH agonist protocol: a single-centre, retrospective, propensity score matched cohort study. Reprod Biol Endocrinol. 2022;20(1):1-11. [DOI:10.1186/s12958-022-01014-0] [PMID] [PMCID]