Carlo Alviggi

Reproductive Medicine, University of Naples Federico II
  • University of Naples Federico II
  • Italy

Recent Comments

May 24, 2018
Replying to Micah J Hill

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?

Thank you for your comment and suggestions.

1 ) This review is the result of an expert meeting held in Naples in 2016 where we initially decided to understand whether the body of evidence was sufficient for the identification of major subgroups of patients. In other word our aim was to initially identify macro-categories for further quantitative approach. Your previous work in patients over 35 was one of the most relevant starting points. Once identified main subgroups, the next step is to perform meta-analysis in each one analyzing different endpoints, maybe to much to condense in a single paper.

2) The issue of potential role of LH in preventing progesterone is still controversial. Despite some papers support your hypothesis , the emerging idea is that this phenomenon is mainly related to the impact of exceeding FSH activity in granulosa cells. The model of MERIT and MEGASET trials seems to support this interpretation. In the MERIT study, when 225 IU of recombinant FSH were compared to 225 IU of FSH/LH, the progesterone rise was more frequent in the former group. Following this observation, it was hypothesized that LH activity counteracted progesterone production. In the subsequent MEGASET trial, when the dose 150 IU was adopted in the two groups, this effects disappeared. This observations is also consistent with papers published by Filicori et al. (J Clin Endocrinol Metab. 1999 Aug;84(8):2659-63; J Clin Endocrinol Metab. 2002 Mar;87(3):1156-61) in the late Nineties. In addition, the enzymatic pathway for androgenesis in human ovary does not seem consistent with the hypothesis that LH can counteract FSH related progesterone rise. I think that literature on this issue is not conclusive and well designed trials aimed to directly investigate into this intriguing topic are required.