Endocrinology: The role of luteinizing hormone in human follicle development and oocyte fertility: evidence from in-vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone

Abstract

To evaluate the relative importance of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in follicular development and oocyte fertility in the human species, the use of recombinant human FSH, human menopausal gonadotrophin (HMG), and very highly purified urinary human FSH (FSH-HP) plus oestradiol valerate for ovarian stimulation and in-vitro fertilization (IVF) were compared in three cycles in a woman with isolated congenital gonadotrophin deficiency who had never been treated with ovarian stimulating agents. The total number of ampoules of gonadotrophins used was lower in the HMG treatment cycle. Ovarian response and IVF outcome in the three treatment cycles were as follows: (i) HMG cycle: normal follicular growth, normal pattern of oestradiol and inhibin through the menstrual cycle, high fertilization rate (93%); (ii) recombinant FSH cycle: normal follicular growth, low oestradiol and abnormal inhibin, finally poor rate of fertilization (28%); (iii) FSH-HP plus oestradiol valerate cycle: normal follicular growth, normal pattern of inhibin and poor fertilization rate (27%). Luteal plasma progesterone concentrations were much higher in the HMG treatment cycle. This case shows that FSH is the only factor required in order to induce follicular growth in the human, although LH or a product derived from its action may assist in order to achieve full follicular maturity and oocytes capable of fertilization. Though oestradiol might have a mediatory role in the process of follicular maturation, our results favour a direct primary role of LH in complete maturation of the follicle.

Follicular fluid hormonal profile and cumulus cell gene expression in controlled ovarian hyperstimulation with recombinant FSH: effects of recombinant LH administration

“…• r-FSH ▼ r-FSH + r-LH; *P<0.05 addition of LH occurs in the late phase of follicular development, LH-Rs are already present on GCs that can now respond to LH and initiate luteinization with an increased production of P 4 and decreased E 2 .…”

“…In fact, although pharmacological doses of FSH alone are capable of stimulating ovarian follicular development, LH is strictly necessary to achieve final follicular maturation and oocyte fertilization [4,11]. Standard stimulation regimens typically use exogenous FSH or human menopausal gonadotropin (hMG) in conjunction with gonadotropin-releasing hormone agonists (GnRH-a) to suppress endogenous gonadotropin release [50].…”

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

“…Although both gonadotropins are necessary for normal follicular development and appropriate steroidogenesis, it has been documented that FSH plays an important role in ovarian stimulation protocols; small amounts of LH are needed to promote a suitable secretion of estradiol and also enable the follicle to undergo final maturation when exposed to hCG (human chorionic gonadotropin). On the other hand, it is known that elevated concentrations of LH in the follicular phase may affect folliculogenesis, resulting in the ovulation of post-mature oocytes (Balasch et al, 1995).…”

The Use of rLH, HMG and hCG in Controlled Ovarian Stimulation for Assisted Reproductive Technologies

“…There are numerous RCT evaluating rLH plus rFSH versus rFSH alone, but the data is complicated by significant heterogeneity between the trials (29,30,(36)(37)(38)(39)(40)(41)(86)(87)(88)(89)(90)(91)(92)(93)(94)(95). The fact that the rLH dose can be administered at a separate starting time and doses from the rFSH dose has allowed researchers and clinicians to be more varied in the approach to rLH administration as compared to hMG.…”