Determination of ovulation time has long been important in the resolution of infertility problems. More recently, it has assumed added significance for the timing of retrieval of oocytes to be used for in vitro fertilization. Because the onset of
the
luteinizing hormone (LH) surge is the most reliable indicator of impending ovulation identifying the beginning of the LH surge is critical for determining the appropriate time of oocyte collection.
It has been suggested that LH surge was preceded or accompanied by increase in serum 17-α-hydroxyprogesterone (17-OHP) levels in natural ovulatory cycle. This study evaluates whether measurement of serum 17-OHP which should be closely associated
with
the onset of LH surge could reliably identify a spontaneous LH surge in women undergoing controlled ovarian hyperstimulation (COH)
In 96 patients who underwent IVF-ET or GIFT from August to December, 1989 at SNUH, serum 17-OHP levels were evaluated and correlated with occurrence of LH surge. The incidence land characteristics of LH surge and its effects on the outcome of COH
were
also measured and compared between LH surge group (N=30) and non-LH surge group (N=66).
Spontaneous LH surge occurred in 30 (31.3%) out of 96 patients studied. Serum E2 levels on Day-1, Day 0 and Day+1, serum LH levels on Day-1 and Day 0 were significantly increased in LH surge group. The number of oocytes retrieved were
significantly
lower in the LH surge group. Nevertheless, there were no significant differences in the cleavage rate of oocyte and the pregnancy rate of oocyte and the pregnancy rate between two groups.
Occurrence rate of LH surge increased significantly as serum 17-OHP level or rising rate of serum 17-OHP increased and the serum LH levels correlated significantly to 17-OHP levels and the rising rate of 17-OHP on the day of LH surge. When serum
17-OHP
level higher than 2.0ng/ml and the rising rate of 17-OHP higher than 2 was used as an arbitary criterion, predictability of LH surge was 84.6%.
In conclusion, monitoring of serum 17-OHP levels can improve the predictability of the occurrences of an endogenous LH surge and allow the clinician to administer hCG coincidently with the onset of the LH release.
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