Does the addition of recombinant LH in WHO group II anovulatory women over-responding to FSH treatment reduce the number of developing follicles? A dose-finding study

Hugues, Jean‐Noël; Soussis, J.; Calderon, Iracema de Mattos Paranhos; Balasch, Juan; Anderson, Richard A.; Romeu, A.

doi:10.1093/humrep/deh682

Cited by 56 publications

(25 citation statements)

References 23 publications

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“…This could be beneficial by accelerating leading follicle development thereby decreasing the overall duration of treatment, particularly in those patients with a tendency to over-respond (hyperstimulate) with standard FSH stimulation (21). The concept of a 'window' for LH has arisen from findings that not only can LH stimulate GC proliferation and steroidogenesis but that in high doses it can cause follicle atresia or luteinisation.…”

Section: Lh Componentmentioning

confidence: 99%

GnRH analogues: applications in assisted reproductive techniques

Hayden

2008

European Journal of Endocrinology

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The ability to prevent an endogenous LH surge revolutionised the efficacy of assisted reproductive techniques (ART) such that GnRH agonists were rapidly adopted in the 1980s. Prior to this, premature luteinisation occurred in up to 25% of superovulated cycles leading to cycle cancellation and severely compromised outcomes. Analogues have been applied in a variety of drug protocols (long, short flare) but there has been little research to moderate the degree of pituitary suppression. There has also been ongoing and unresolved debate about the role of LH in supporting follicular development.By 2001, the first GnRH antagonists were registered for use in ART. Their ability to cause immediate suppression of gonadotrophin (particularly LH) secretion means that they can be given after exogenous stimulation has begun and thereby dramatically shorten the total duration of a treatment cycle. After initial enthusiasm and then scepticism that pregnancy rates may not be as high as the established agonist regimens, these preparations are now being increasingly adopted with at least comparable outcomes in large trials. They are certainly favoured by patients for their reduced side-effect profile and particularly for the shortening of the total cycle length. This shift in practice is occurring alongside gathering momentum in favour of milder stimulation protocols and a new perception of what constitutes successful treatment. The focus is moving away from surrogate outcomes such as oocyte numbers and conception rates towards long-term outcomes for women and their offspring, namely the achievement of a live singleton birth per treatment started.

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Section: Lh Componentmentioning

confidence: 99%

GnRH analogues: applications in assisted reproductive techniques

Hayden

2008

European Journal of Endocrinology

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“…Currently available evidence indicates that rFSH alone may not be sufficient to promote optimum follicular growth in severely gonadotropin-deficient women 12,17…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women

Papaleo

Alviggi

Colombo

et al. 2014

TCRM

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BackgroundHypogonadotropic hypogonadal women are characterized by ovarian functionality deficiency, caused by low concentrations of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). To recover reproduction functionality, recommended therapies for ovarian induction involve injections of FSH and LH medications.ObjectiveSince important differences exist between recombinant and urinary gonadotropin therapies in terms of efficacy and cost, the objective of this study was to develop a cost-effectiveness model to compare recombinant FSH (rFSH) + recombinant LH (rLH) and highly purified human menopausal gonadotropin (HP-HMG).MethodsA Markov model was developed, considering three cycles of therapy; probability of pregnancy and miscarriage were considered, and the efficacy was evaluated in terms of pregnancy occurrence. The perspective of the model was that of the Italian Health Service, so only direct cost (drugs, specialist visits, patient examinations, and hospitalizations) were included.ResultsrFSH + rLH is associated with a higher total cost (€3,453.50) and higher efficacy (0.87) compared with HP-HMG (€2,719.70 and 0.50). rFSH + rLH generated an incremental cost effectiveness ratio equal to €2,007.30 compared to HP-HMG; the average cost per pregnancy is estimated to be €3,990.00 for recombinant strategy and €5,439.80 for urinary strategy. Results of probabilistic sensitivity analysis were consistent with the abovementioned findings.ConclusionDespite the higher acquisition cost in comparison to HP-HMG, rFSH + rLH resulted in a higher pregnancy rate, which makes it the recommended choice when considering cost-effectiveness of LH in supporting FSH-induced follicular gonadotropins in hypogonadotropic hypogonadal women.

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“…While the addition of rLH may increase response in COH, very high doses of rLH (660 IU/day) in anovulatory women, who are at particular risk of ovarian hyperstimulation, may promote the growth of a single dominant follicle [8], thereby reducing her risk for ovarian hyperstimulation syndrome. It has therefore been hypothesized that high dose rLH supplementation may reduce the size of the developing follicular cohort.…”

Section: Introductionmentioning

confidence: 99%

Discontinuation of rLH two days before hCG may increase the number of oocytes retrieved in IVF

Spencer

Browne

Copland

et al. 2010

Reprod Biol Endocrinol

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BackgroundAdministration of recombinant luteinizing hormone (rLH) in controlled ovarian hyperstimulation may benefit a subpopulation of patients. However, late follicular phase administration of high doses of rLH may also reduce the size of the follicular cohort and promote monofollicular development.MethodsTo determine if rLH in late follicular development had a negative impact on follicular growth and oocyte yield, IVF patients in our practice who received rFSH and rLH for the entire stimulation were retrospectively compared with those that had the rLH discontinued at least two days prior to hCG trigger.ResultsThe two groups had similar baseline characteristics before stimulation with respect to age, FSH level and antral follicle count. However, the group which had the rLH discontinued at least two days prior to their hCG shot, had a significantly higher number of oocytes retrieved, including a higher number of MII oocytes and number of 2PN embryos.ConclusionsWhen using rLH for controlled ovarian hyperstimulation, administering it from the start of stimulation and stopping it in the late follicular phase, at least two days prior to hCG trigger, may increase oocyte and embryo yield.

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Does the addition of recombinant LH in WHO group II anovulatory women over-responding to FSH treatment reduce the number of developing follicles? A dose-finding study

Cited by 56 publications

References 23 publications

GnRH analogues: applications in assisted reproductive techniques

GnRH analogues: applications in assisted reproductive techniques

Cost-effectiveness analysis on the use of rFSH + rLH for the treatment of anovulation in hypogonadotropic hypogonadal women

Discontinuation of rLH two days before hCG may increase the number of oocytes retrieved in IVF

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