Atypical luteinizing hormone rise and associated fertilization failure in non-male factor in vitro fertilization...

The purpose of this investigation was to analyze fertilization failure in non-male factor infertility in vitro fertilization (IVF) patients. Twenty-five nonfertilized IVF patients were compared with 57 successfully fertilized IVF patients. Patients were matched for age, ovulation-induction protocol, and cycle. The two groups were similar with respect to infertility etiology, peak estradiol, and total oocytes retrieved at laparoscopy. There was a greater incidence of primary infertility (64 versus 49%) and mean years of infertility (5.4 +/- 0.4 versus 4.6 +/- 0.3) in the nonfertilization group, although these differences were not statistically significant. Most important, the nonfertilization patients had a greater incidence of an atypical LH rise prior to hCG administration (60 versus 18%; P less than .001) and fewer mature oocytes (2.0 +/- 0.3 verus 3.4 +/- 0.3; P less than .01). Stepwise linear regression analysis yielded four primary factors for predicting fertilization failure: infertility duration, primary infertility, number of mature oocytes, and presence of LH rise. These findings help characterize several potential factors other than oligozoospermia that are associated with nonfertilization, and support LH monitoring in IVF and gamete intrafallopian tube transport patients.