The effect of adding exogenous LH to IVF/ICSI cycles on pregnancy outcomes in elderly women with PCOS: a retrospective cohort study
Authors: Ju Wenhan , Zhao Shuai , Song Jingyan , Wu Haicui , Lu Xiaoliu , Guan Lu , Xiang Shan , Lian Fang 
Published: October 2022

Background
Polycystic ovary syndrome (PCOS) patients have more sinus follicular reserve than normal women. However, deteriorating oocyte quality with advancing age is a major problem in PCOS patients undergoing in vitro fertilization (IVF) / intracytoplasmic single sperm injection (ICSI) assisted conception and improved controlled ovarian hyperstimulation (COH) cycle dosing regimens remain critical. Current findings on the necessity of adding exogenous luteinizing hormone (LH) to IVF/ICSI cycles in women with elderly PCOS (≥ 35 years) are controversial. This study investigated the clinical efficacy of adding exogenous LH to antagonist regimens in IVF/ICSI-assisted conception cycles for elderly patients with PCOS.
Methods
Clinical data of PCOS patients who underwent IVF/ICSI-assisted conception at Reproductive and Genetic Center, Affiliated Hospital of Shandong University of Traditional Chinese Medicine， between January 1, 2018, and April 30, 2022, were collected for retrospective cohort analysis. Groups 1 (exogenous follicle-stimulating hormone (FSH) only, n = 170) and 2 (exogenous FSH and LH, n = 265) were divided according to whether exogenous LH was added to the gonadotropin-releasing hormone antagonist (GnRH-ant) regimen, and binary logistic regression analysis was used to examine the association between the addition of exogenous LH and pregnancy outcome. Furthermore, subgroup analysis was performed on the clinical data of the group 2. Group 2A (recombinant-human luteinizing hormone, n = 30) and 2B (human menopausal gonadotropin for injection, n = 235) were classified by exogenous LH additive type. Group 2C (75 u, n = 149) and 2D (150 u, n = 116) were classified by the additive amount of exogenous LH. Group 2E (exogenous LH added on Gonadotropins(Gn) initiation day, n = 137) and 2F (exogenous LH added after Gn initiation day, n = 128) were classified by whether exogenous LH was added on Gn initiation day one. COH and conception outcomes were compared between the two groups.
Results
The number of follicles ≥ 14 mm on trigger day, eggs obtained, fertilized eggs, normally fertilized eggs, and high-quality embryos, and the cumulative clinical pregnancy rate were significantly higher in group 1 than in group 2 (P < 0.05). The binary logistic regression indicated that adding exogenous LH was an independent risk factor for cumulative clinical pregnancy rate (OR = 2.024, P = 0.001). In contrast, among the subgroups with the addition of exogenous LH, there were no statistically significant differences between the different dose subgroups, groups 2A and 2B, groups 2C vs. group 2D for the first additive dose, and groups 2E vs. group 2F for whether or not to add on the initiation day.
Conclusion
For most elderly women with PCOS, particularly those with body mass index (BMI) < 25 kg/m2, the addition of exogenous LH during IVF/ICSI cycles resulted in decreased efficacy in assisted conception outcomes, and there was no evidence that the additive type and amount, and timing of LH addition effected assisted conception outcomes.