The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome
Keywords:Infertility, LH, Ovulation, PCOS
Background: Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder in infertile women. Raised tonic levels of luteinizing hormone (LH) is one of the main endocrinological disturbances in PCOS patients. Objective of present study was to evaluate the effect of baseline serum luteinizing hormone levels on follicular development, ovulation and conception and pregnancy outcome in infertile patients with PCOS.
Methods: This is a prospective study conducted on 50 consecutive infertile patients with PCOS. Baseline Day 2 serum luteinizing hormone concentration was done in selected patients. Ovulation induction was done with clomiphene citrate 100 mg from Day 3 to Day 7 of the cycle. Then patients were monitored for follicular development, ovulation, conception and early pregnancy loss.
Results: The mean age of the patients is 25±3.6 yrs. The average duration of infertility is 5.4 yrs (2-10). The mean basal serum LH concentration in patients who ovulated was significantly low (5.6 IU) in comparison with patients who did not ovulate (10.1 IU). The mean basal serum LH concentration in patients who conceived was 3.9 IU in comparison with patients who did not conceive (5.9 IU) which was statistically significant (p=0.04). Out of 15 patients who conceived, 3 patients (20%) had early pregnancy loss.
Conclusions: Tonic hyper secretion of LH results in premature oocyte maturation, causing the problems with fertilization and miscarriage. Inappropriately raised LH appears to have deleterious effects on the pregnancy outcome.
Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8:41.
Tartatzis BC, Grimbizis G. assisted reproduction techniques in polycystic ovarian syndrome. Ann NY Acad Sci. 1993;687:280-7.
Turhan NO, Artini PG, D Ambrogio G, Grogheni P, Battagha C, Gennazani AD. A comparative study of three ovulation induction protocols in polycystic ovarian disease patients in an in-vitro fertilization embryo transfer program. J Assist Report Genet. 1993;10:15-20.
Stranger JD, Yovich JL. Reduced in-vitro fertilization of human oocytes from patients with raised basal luteinizing hormone levels during the follicular phase. Br J Obstet Gynecol. 1985 Apr;92(4):385-93.
Howles CM, Macnamee MC, Edwards RG, Goswamy R, Steptoe PC. Effect of high tonic concentrations of luteinising hormone on outcome on in-vitro fertilization. Lancet. 1986;30:521-2.
Balen AH, Tan SL, Jacob HS. Hyper secretion of luteinizing hormone. A significant cause of infertility and miscarriage. Br J Obstet Gynecol. 1993 Dec 1;100(12):1082-9.
Stein IF, Leventhal ML. Amenorrhea associated with bilateral polycystic ovaries. Am J Obstet Gynecol. 1935;29:181-191
Fr DD, Tarlatzis R. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81:19-25.
Judd HL. Endocrinology of polycystic ovarian disease. Clin Obstet Gynecol. 1978;21:99-114.
Fawn BC. Observation in favour of normal early follicle development and disturbed dominant follicle selection in polycystic ovary syndrome. Gynecol Endocrinol. 1994 Jan;8(2):75-82.
Homburg R, Armar NA, Eshel A, Adams J, Jacobs HS. Influence of serum luteinising hormone concentrations on ovulation, conception, and early pregnancy loss in polycystic ovary syndrome. BMJ. 1988 Oct;297(6655):1024-6.
Shoham Z, Jacobs HS, Insler V. Luteinizing hormone: its role, mechanism of action, and detrimental effects when hyper secreted during the follicular phase. Fertil Steril. 1993;59:1153-6.
Baillieres HR. Adverse effects of luteinizing hormone on fertility: fact or fantasy. Clin Obstet Gynaecol. 1998 Dec;12(4):555-63.
Regan L, Owen EJ, Jacobs HS. Hyper secretion of luteinising hormone, infertility, and miscarriage. Lancet. 1990;336:1141-4.
Tarlatzis BC, Grimbizis G. The significance of high follicular phase luteinizing hormone levels in the treatment of women with polycystic ovarian syndrome by invitro fertilization. J Assist Reprod Genet. 1997 Jan 1;14(1):1-4.
Kolibianakis EM, Zikopoulos K, Schiettecatte J, Smitz J, Tournaye H, Camus M, et al. Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF. Human Reprod. 2004 Nov 1;19(11):2490-6.
Watson H, Kiddy DS, Hamilton-Fairley D, Scanlon MJ, Barnard C, Collins WP et al. Hyper secretion of luteinizing hormone and ovarian steroids in women with recurrent early miscarriage. Hum Reprod. 1993;8:829-33.
Zhong YP, Ying Y, Wu HT, Zhou CQ, Xu YW, Wang Q, et al. Comparison of endocrine profile and in vitro fertilization outcome in patients with PCOS, ovulatory PCO, or normal ovaries. Int J Endocrinol. 2012 Feb 28;2012.
Humaidan P, Bungum L, Bungum M, Andersen CY. Ovarian response and pregnancy outcome related to mid-follicular LH levels in women undergoing assisted reproduction with GnRH agonist down-regulation and recombinant FSH stimulation. Human Reprod. 2002 Aug 1;17(8):2016-21.