ABSTRACT
To assess the effect of LH level on day 1 of ovarian stimulation in down regulated women on the outcome of ICSI cycles. Moreover, there was a study of a possible effect of altering the timing of HCG administration on pregnancy rates in these cycles. Prospective randomized controlled study. Private centre. 115 patients undergoing ICSI. In all patients, the long luteal down regulation protocol was used. After downregulation confirmation by ultrasound and estradiol < 50 pg/mI, LH was measured before starting controlled ovarian hyperstimulation [COH]. Then, according to timing of HCG administration, patients were randomely divided into two groups, group A: HCG administered when at least 3 follicles > or = 17 mm and group B HCG administered when at least 3 follicles > 19 mm. Regarding LH level on day 1 of COH, receiver-operating characteristic [ROC] analysis was used to estimate any possible cutoff value as a predictor of pregnancy. The ROC curve revealed a value of 2.5 IU/L, [with an area under curve ROCAUC 0.705, 95% CI: 0.607-0.803] above this value, there was significant decrease in clinical pregnancy rates. Furthermore, delay the timing of HCG administration, in group B did significantly decreased pregnancy rates [61.4% and 38.6% respectively in group A and B]. In long agonist protocol, LH value > 2.5 IU/L after down- regulation is a poor prognostic value. So, prolongation of down regulation could be considered. Moreover, earlier administration of HCG is associated with higher pregnancy rates