A review of luteinizing hormone and its role in ovarian reserve testing

Abstract

Ovarian reserve tests (ORTs) have become part of the antecedent workup for individuals undergoing assisted reproductive technology (ART). In 1988, the foundations for ORTs were first laid by studies indicating a potential role for basal follicle stimulating hormone (FSH) in predicting pregnancy. 1Since then basal FSH measurement has gone on to become the most commonly used marker of ovarian reserve.2 Given the synergistic interplay of both FSH and luteinizing hormone (LH) in ovarian physiology which ARTs attempt to mimic, it is of interest that LH has not been explored in the same capacity. This review aims to illustrate the physiological role played by LH in folliculogenesis and critically review the available literature to determine if LH does indeed have a role in ovarian reserve testing. OVARIAN RESERVE TESTINGThe term ovarian reserve aims to correlate reproductive potential with the number and quality of remaining oocytes in women of reproductive age.3 Ovarian reserve testing aims to quantify this relationship by measuring either oocyte quality, quantity or the ability for an individual to achieve pregnancy. These tests can be conducted either through biochemical means or through ultrasonographic measures. ABSTRACTBackground: Ovarian physiology illustrates the synergistic interaction between luteinizing hormone and follicle stimulating hormone in the process of folliculogenesis. While follicle stimulating hormone has been well established as a marker of ovarian reserve, the role of luteinizing hormone has remained somewhat controversial and it seems to have become the 'forgotten gonadotropin'. The following review aims to investigate the available evidence surrounding luteinizing hormone as an ovarian reserve test and examine the issues which need to be addressed in order to establish it as an ovarian reserve test. It then further attempts to propose a model to direct effective research to ascertain if it does have a role to play in ovarian reserve testing. Findings: The evidence is equivocal in the use of luteinizing hormone as an independent predictor of ovarian reserve. However, there is much stronger evidence to suggest that the follicle stimulating hormone/luteinizing hormone ratio is a useful marker of ovarian reserve-in particular when it is ≥2 and approaching 3. The evidence base for this ratio at present however is sparse. In addition, ovarian reserve tests are fraught with issues over reliability, accuracy, definition and the implications of testing itself. In order to overcome these issues, more quality research needs to be carried out to test this relationship between luteinizing hormone and follicle stimulating hormone.

Anti-Mullerian Hormone:Above and Beyond Conventional Ovarian Reserve Markers

“…It has a decisive role in ovarian steroidogenesis and ovulation. It progressively increases across the follicular phase of menstrual cycle and peaks at the time of ovulation [ 30 ]. LH receptors are more sparsely located on dominant follicle than the smaller follicles, allowing them to continue growing, compared to others [ 30 ].…”

“…It progressively increases across the follicular phase of menstrual cycle and peaks at the time of ovulation [ 30 ]. LH receptors are more sparsely located on dominant follicle than the smaller follicles, allowing them to continue growing, compared to others [ 30 ]. These antral follicles under the influence of LH rapidly synthesized estradiol, essential for oocyte maturation and endometrium readiness for implantation.…”

FSHR gene polymorphisms affect the ovarian response to rFSH stimulation in Egyptian patients undergoing ARTs

“…It is also defined as an estimate of oocytes remaining in the ovary that are capable of fertilization resulting in a healthy and successful pregnancy [23]. Ovarian reserve testing aims to quantify this relationship by measuring either oocyte quality, quantity, or the ability of an individual to achieve pregnancy, either through biochemical measures or through ultrasound imaging of the ovary [24]. They were expected to help identify individuals who would be unlikely to achieve pregnancy through ARTs [20].…”

The Use of Concentration of Anti-Mullerian Hormone (AMH) as an Indicator of Reproductive Performance in Livestock Species

“…Filion et al (2001) reported that in response to the LH surge in humans, the E series prostaglandins (mainly PGE 2 ) are produced by the follicle which is essential for the successful rupture of the follicle and release of the oocyte into the periovarian space. In addition, LH stimulates and prepares the granulosa cells for luteinization (Smith et al, 2014;Stouffer et al, 2007). Hydration of these cumulus cells which produce hyaluronic acid, enables cumulus expansion through the enlargement of the space between granulosa cells (Eppig, 2001).…”