Current opinion on use of luteinizing hormone supplementation in assisted reproduction therapy: an Asian perspective

Abstract

LH and FSH have complementary functions in ensuring optimal oocyte maturation and ovulation. In women undergoing assisted reproduction technology protocols with gonadotrophin-releasing hormone analogues, LH and FSH concentrations are reduced. While FSH use in assisted reproduction technology is well established, there is no published consensus on the need for exogenous LH in Asian patients. Having reviewed the concept of the LH therapeutic window and differences between recombinant human LH (r-HLH) and human menopausal gonadotrophin, a consensus was reached on which patient subgroups may benefit from LH supplementation. Adjuvant r-HLH gives clinicians precise control over the dose of LH bioactivity administered to target the therapeutic window. The use of r-HLH is recommended in women with poor response in a previous cycle or suboptimal follicular progression in a current cycle by day 6-8 of stimulation. r-HLH should also be considered in women at risk of suboptimal response, specifically age > 35 years. Other risk markers that suggest the need for LH supplementation, which include baseline/day-6 serum LH and anti-Müllerian hormone concentrations, antral follicle count and LH polymorphisms require further research and verification. For measurement of LH response adequacy, the monitoring of follicular progression, oestradiol concentrations and endometrial thickness is recommended.

Luteinizing hormone and follicle stimulating hormone synergy: A review of role in controlled ovarian hyper-stimulation

“…The poor outcome of COH includes increased age (above 35 years), poor ovarian reserve, poor response to previous ART cycles, genetic variations and hormonal status majorly LH, FSH, estradiol and anti-Mullerian hormone (AMH). [6] Overall, these studies suggest that LH supplementation could be beneficial for a particular sub-population, including older patients and poor responders. This might be due to the better ooctye quality resulting from a restored follicle at the end of stimulation in these ART patients.…”

“…This is an area that warrants further research. [6] Studies have shown that serum LH levels should be between 1.2 IU/L and 5.0 IU/L,[8] for optimal development follicle in cycles where endogenous LH is suppressed. [619]…”

“…[26] However, it is critical that add-back LH is administered in appropriate patients as an excess of LH can cause suppression of granulosa cells and follicular atresia. [626]…”

“…The Asia Pacific Fertility Advisory Group[6] in 2011 strongly recommended r-hLH co-treatment with r-hFSH in patients with a history of poor response as in:…”

“…Wong et al recommended that further research is needed in patients with suboptimal response based on the following biomarkers: (i) AFC < 6 in both ovaries; (ii) AMH concentration <1.5 ng/mL; and (iii) LH polymorphisms. [6]…”