Use of recombinant luteinizing hormone for controlled ovarian hyperstimulation in infertile patients

Abstract

Controlled ovarian stimulation has become an integral part of a high complexity infertility treatment. Treatment options with recombinant gonadotrophins add more to knowledge on folliculogenesis and ovarian steroidogenesis. Therefore, a literature search was conducted in the following data bases: Medline, Scielo and PubMed. The descriptors/key words used were ovarian stimulation, in vitro fertilization, recombinant luteinizing hormone, supplementation LH. The aim of this study was to review the available literature and to assess the benefits of using recombinant luteinizing hormone associated with recombinant follicle stimulating hormone in different populations who have undergone assisted reproduction procedures.

rLH/rFSH Combination Improved Cumulative Live Birth Rate in Patients With LH Over-Suppression Following GnRH Agonist Pituitary Down-Regulation Compared to rFSH or hMG Alone: A Retrospective Cohort Study With Propensity Score Matching

“…Previous studies also found that patients with low serum LH levels achieved better clinical pregnancy rates after adding exogenous LH [15,[21][22][23][24]. Franco et al report that supplementation with rLH signi cantly increases the number of fertilized oocytes obtained and the rate of cumulative live births [25]. In the current study, patients whose LH level decreased by ≥ 50% on the day of Gn initiation were included as subjects.…”

Effect of Exogenous Luteinizing Hormone (LH) Supplementation on Clinical Pregnancy of Patients Receiving Long-Acting Gonadotropin-Releasing Hormone Agonist (GnRHa) Cycles: A Retrospective Cohort Study

“…Some previous studies also considered that endogenous LH could meet the needs of follicular development in most patients with a normal ovarian response, and the addition of exogenous LH is not necessary. 10 , 11 , 17 , 18 Chappel et al 19 suggested that a few LH receptors (less than 1%) in most patients were enough to maintain normal steroid production and follicular development. When GnRH agonists or antagonists decrease the level of endogenous LH, the “resting state” of the LH concentration may be sufficient.…”

Pregnancy confirmed after controlled ovarian stimulation for infertility

“…According to this, there is not only a threshold requirement for LH to guarantee follicular development but also a ceiling level beyond which LH might inhibit the proliferation of granular cells and induce luteinization of follicles before ovulation, resulting in impaired oocyte and embryo quality [3–5] . Some studies have suggested that LH supplementation has a beneficial effect on the maturation and fertilization of oocytes in patients who are undergoing pituitary down-regulation with significant serum LH suppression [6–8] . However, it has been consistently reported that high LH levels during the follicular phase are associated with poor oocyte and embryo quality, with a negative impact on IVF outcome [9,10] .…”

“…[3][4][5] Some studies have suggested that LH supplementation has a beneficial effect on the maturation and fertilization of oocytes in patients who are undergoing pituitary down-regulation with significant serum LH suppression. [6][7][8] However, it has been consistently reported that high LH levels during the follicular phase are associated with poor oocyte and embryo quality, with a negative impact on IVF outcome. [9,10] Nonetheless, there is no consensus about the specific threshold of the LH window during follicular development.…”