Recombinant luteinizing hormone supplementation in assisted reproductive technology: a systematic review

A large body of evidence indicates that luteinizing hormone plays a crucial role during folliculogenesis and that its supplementation may be useful in specific sub- groups of women undergoing assisted reproductive technology.

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Volume 109, Issue 4, Pages 644–664

Abstract:

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)

Abstract:

Objective

To assess the role of recombinant human LH (r-hLH) supplementation in ovarian stimulation for ART in specific subgroups of patients.

Design

Systematic review.

Setting

Centers for reproductive care.

Patient(s)

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.

Intervention(s)

Systematic review.

Main Outcome Measure(s)

Implantation rate, number of oocytes retrieved, live birth rate, ongoing pregnancy rate, fertilization rate, and number of metaphase II oocytes.

Result(s)

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.

Conclusion(s)

Recombinant hLH can be proposed for hyporesponders and women 36–39 years of age.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Micah J Hill
Micah J Hill 8 days ago

Thank you for a great expert review of rLH in ART stimulation!

1. It seems you showed great restraint in not performing statistical meta-analysis of the data.  Could you elaborate on why you felt the data was appropriate for statistical synthesis?

2. Do you think another potential benefit of exogenous LH activity is reducing premature progesterone rise, given that it encourages 5delta steroid synthesis and CYP 17 activity, reducing progesterone build up?