Volume 109, Issue 4, Pages 644–664
Carlo Alviggi, M.D., Ph.D., Alessandro Conforti, M.D., Sandro C. Esteves, M.D., Ph.D., Claus Yding Andersen, D.M.Sc., Ernesto Bosch, M.D., Klaus Bühler, M.D., Anna Pia Ferraretti, M.D., Giuseppe De Placido, M.D., Antonio Mollo, M.D., Ph.D., Robert Fischer, M.D., Peter Humaidan, M.D., D.M.Sc. for the International Collaborative Group for the Study of r-hLH (iCOS-LH)
To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients.
Centers for reproductive care.
Six populations were investigated: 1) women with a hyporesponse to recombinant human FSH (r-hFSH) monotherapy; 2) women at an advanced reproductive age; 3) women cotreated with the use of a GnRH antagonist; 4) women with profoundly suppressed LH levels after the administration of GnRH agonists; 5) normoresponder women to prevent ovarian hyperstimulation syndrome; and 6) women with a “poor response” to ovarian stimulation, including those who met the European Society for Human Reproduction and Embryology Bologna criteria.
Main Outcome Measure(s)
Implantation rate, number of oocytes retrieved, live birth rate, ongoing pregnancy rate, fertilization rate, and number of metaphase II oocytes.
Recombinant hLH supplementation appears to be beneficial in two subgroups of patients: 1) women with adequate prestimulation ovarian reserve parameters and an unexpected hyporesponse to r-hFSH monotherapy; and 2) women 36–39 years of age. Indeed, there is no evidence that r-hLH is beneficial in young (<35 y) normoresponders cotreated with the use of a GnRH antagonist. The use of r-hLH supplementation in women with suppressed endogenous LH levels caused by GnRH analogues and in poor responders remains controversial, whereas the use of r-hLH supplementation to prevent the development of ovarian hyperstimulation syndrome warrants further investigation.
Recombinant hLH can be proposed for hyporesponders and women 36–39 years of age.