Self-Detection of the LH Surge in Urine After GnRH Agonist Trigger in IVF-How to Minimize Failure to Retrieve Oocytes.

Research question: Urine LH testing may be useful to confirm an LH surge after the GnRH agonist (GnRHa) trigger prior to oocyte retrieval in IVF. Design: A prospective cohort study, including oocyte donors undergoing ovarian stimulation, treated with a GnRHa trigger for final oocyte maturation. Urine LH testing was performed at home, 12 h after the GnRHa trigger. In the case of a negative result, serum LH and progesterone measurements were done that same day. Donors with no serum LH peak after trigger were re-scheduled using a dual trigger, with GnRHa and hCG. Results: Three hundred and fifty nine oocyte donors were included in the analysis. Three hundred and fifty six donors had positive urine LH tests, followed by oocyte retrieval. In one case, the LH test was positive, however, no oocytes were retrieved (false positive 1/356). Three LH tests were negative in urine: in one of these three cases, LH was tested again in blood, confirming an LH rise, consistent with an optimal response to the GnRHa trigger; in the other two cases, serum LH was <15 mUI/mL, after which the oocyte retrieval was re-scheduled for 36 h after an being re-triggered, resulting in the retrieval of 19 and 22 MII oocytes, respectively. Considering the cost analysis, it would be a significantly cost-saving strategy, as blood testing would have costed 14,840€ vs. only 185.5€ in urine LH kits. Conclusions: Urinary testing of the LH surge after GnRHa trigger is easy, safe, reliable, and convenient. In addition, LH urine testing allows identifying donors and patients who could benefit from a rescue hCG trigger after an unsuccessful GnRHa trigger.

Letrozole administration during the luteal phase after ovarian stimulation impacts corpus luteum function: a randomized, placebo-controlled trial.

OBJECTIVE: To investigate the effect of letrozole-an oral aromatase inhibitor-on E(2), P, and LH levels when administered during the luteal phase after oocyte retrieval in IVF/intracytoplasmic sperm injection (ICSI) cycles. DESIGN: Prospective, randomized, placebo controlled trial. SETTING: University-affiliated private reproductive medicine center. PATIENT(S): Thirty oocyte donors undergoing standardized controlled ovarian hyperstimulation (COH) protocols. INTERVENTION(S): Patients were randomized after successful egg retrieval to receive either 2.5 mg of letrozole (Femara; Novartis, Barcelona, Spain) or a placebo (folic acid tablets). All donors were under intrauterine device (IUD) contraception. MAIN OUTCOME MEASURE(S): Serum E(2), P, and LH the day of hCG administration and days +4, +7 and +10 after ovum pick-up. RESULT(S): Donors had a comparable serum E(2) level on the day of hCG administration (1,858 vs. 2,143 pg/mL). Interestingly, levels dramatically dropped 4 days after egg retrieval, reaching a statistically significant lower level in those receiving letrozole (279 vs. 1,586 pg/mL). Again, at the next time points serum E(2) levels were significantly lower (day +7: 240 vs. 855 pg/mL and day +10: 40 vs. 448 pg/mL). No significant differences were observed in P levels, but LH serum concentrations were lower in the control group on day +7 (0.18 vs. 0.02 mIU/mL and day +10 (0.40 vs. 0.16 mIU/mL), when serum E(2) levels were higher. CONCLUSION(S): The administration of 2.5 mg of letrozole during the luteal phase has an impact on corpus luteum (CL) function. It reduces serum E(2) levels, which allows a faster recovery of LH concentration. This may be of interest not only for egg donors, but also in patients at high risk of ovarian hyperstimulation syndrome (OHSS) who freeze all their embryos or who cancel hCG administration to reduce the potential risk that high E(2) levels pose.