Is there a critical LH level for hCG trigger after the detection of LH surge in modified natural frozen-thawed single bl
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ASSISTED REPRODUCTION TECHNOLOGIES
Is there a critical LH level for hCG trigger after the detection of LH surge in modified natural frozen-thawed single blastocyst transfer cycles? Semra Kahraman 1
&
Yucel Sahin 1
Received: 23 May 2020 / Accepted: 7 October 2020 # The Author(s) 2020
Abstract Purpose There is no consensus yet in the literature on an optimal luteinizing hormone (LH) level for human chorionic gonadotrophin (hCG) trigger timing in patients undergoing frozen-thawed embryo transfer (FET) with modified natural cycles (mNC). The objective of our study was to compare the clinical results of hCG trigger at different LH levels in mNC-FET cases. Methods This retrospective study was conducted in Istanbul Memorial Hospital ART and Genetics Center. A total of 1076 cases with 1163 mNC-FET cycles were evaluated. LH levels between the start of LH rise (15 IU/L) and LH peak level (> 40 IU/L) were evaluated. Cycles were analyzed in four groups: group A (n = 287) LH level on the day prior to the day of hCG; groups B, C and D, LH levels on the day of hCG: group B (n = 245) LH 15–24.9; group C (n = 253), LH 25–39.9; group D (n = 383) LH ≥ 40. Cycle outcomes in the four groups were compared. Results Subgroup analyses of mNC-FET groups showed that implantation, clinical and ongoing pregnancy rates, and pregnancy losses were not significantly different in patients with different LH levels on the day of hCG trigger. Conclusion Our study suggests that hCG can be administered at any time between the start of LH rise (≥ 15 IU/L) and LH peak level (≥ 40 IU/L) without a detrimental effect on clinical outcome. Keywords mNC-FET . LH value . hCG day
Introduction Advances in cryopreservation techniques have resulted in a dramatic increase in freeze-all cycles. Reasons for this preference include the higher rate of viable embryos available after thawing and the near elimination of the risk of ovarian hyperstimulation syndrome (OHSS). Furthermore, many studies have shown increased implantation rates when transfer takes place in a more natural uterine environment without elevated levels of hormones [1–4]. Appropriate endometrial preparation therefore plays an essential role in successful implantation in FET cycles. The two main alternative approaches for endometrial preparation are
* Semra Kahraman [email protected] 1
Assisted Reproductive Technologies and Reproductive Genetics Center, Istanbul Memorial Hospital, Piyalepasa Bulvari, Sisli, 34384 Istanbul, Turkey
estrogen and progesterone replacement treatment (artificial cycle) or the use of natural cycle, depending on the regularity or pattern of the menstrual cycle. Because of possible adverse hormonal effects, including a higher risk of thrombo-embolic events, and because of the inconvenience to patients, in our center, the artificial cycle is used only for cases with anovulatory cycles and/or endometrial thinning. In natural cycle, the alternatives are true and modified natural cycles. True natural cycle (tNC)-FET requires strict hormonal and follicular development moni
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