Recombinant human LH supplementation versus recombinant human FSH (rFSH) step-up protocol during controlled ovarian stimulation in normogonadotrophic women with initial inadequate ovarian response to rFSH. A multicentre, prospective, randomized controlled trial

Placido, Giuseppe De; Alviggi, Carlo; Perino, Antonio; Strina, Ida; Lisi, Franco; Fasolino, Antonio; Palo, R. De; Ranieri, A.; Colacurci, Nicola; Mollo, Antonio

doi:10.1093/humrep/deh625

Cited by 151 publications

(96 citation statements)

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“…It has been suggested that rLH supplementation is effective in young, normogonadotrophic patients who demonstrate a suboptimal ovarian response to initial rFSH stimulation [6] or who had required high doses of rFSH in a previous cycle [12]. Unfortunately, we are unable to determine the number of 'suboptimal responders' within our study group to perform such a subgroup analysis.…”

Section: Discussionmentioning

confidence: 93%

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Improved pregnancy rates with luteinizing hormone supplementation in patients undergoing ovarian stimulation for IVF

Paterson

Foong

Greene

2012

J Assist Reprod Genet

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Introduction Luteinizing hormone (LH) is believed to play a role in follicle maturation during the natural cycle. However, the need for co-treatment with recombinant LH (rLH) for controlled ovarian stimulation is controversial. Purpose The primary objective of our study was to determine if pregnancy rates are improved when rLH is used in addition to rFSH for ovarian stimulation. Secondary outcomes were fertilization rate, implantation rate and live birth rate. Methods A retrospective cohort study was performed of 1565 IVF or ICSI cycles. Outcomes were compared between ovarian stimulation cycles from 2007 when rLH and rFSH was used (n0765) to 2006 when rFSH only was used (n-800). Results Improved outcomes were found for rLH + rFSH versus rFSH alone for; pregnancy rate (61% and 54% respectively, p00.006), live birth rate (49% and 42% respectively, P 00.01), fertilization rate (74% versus 72% respectively, p00.04 and implantation rate (41% versus 37% respectively, p00.03).Conclusions Our large retrospective cohort study showed an improved pregnancy rate and live birth rate with rLH supplementation. This was associated with an improved fertilization and implantation rate and therefore may reflect an improvement in oocyte quality and/or uterine receptivity.

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Section: Discussionmentioning

confidence: 93%

“…Specific populations that have been suggested to benefit include patients greater than 35 years of age [1,13,14,16], suboptimal responders to ovarian stimulation ( [6,12,16]) and those undergoing specifically a GnRH antagonist cycle [2] or GnRH agonist cycles [9].…”

Section: Introductionmentioning

confidence: 99%

Improved pregnancy rates with luteinizing hormone supplementation in patients undergoing ovarian stimulation for IVF

Paterson

Foong

Greene

2012

J Assist Reprod Genet

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“…However, in women above 35 years of age, poor responders, or with more severe pituitary GnRH-a suppression, stimulation with r-LH in the mid/late-follicular phase could be associated with improved results [6,12,24,34,37,40,41,47]. In a recent meta-analysis study it has been suggested that the supplementation with r-LH in patients of advanced reproductive age stimulated with r-FSH, may improve implantation and clinical pregnancy without affecting metaphase II (Met II) yield [31].…”

Section: Introductionmentioning

confidence: 99%

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

Barberi

Ermini

Morelli

et al. 2012

J Assist Reprod Genet

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Purpose Down-regulation with gonadodropin-releasing agonist (GnRH-a) protocol during IVF stimulation leads to a severe endogenous LH suppression, which may affect the follicular development. The aim of the study was to evaluate the effects of recombinant LH (r-LH) administration, during late follicular development stages, in recombinant FSH (r-FSH) stimulated cycles on follicular fluid (FF) parameters and on cumulus cell quality. Methods Twenty patients undergoing IVF were stimulated in a long GnRH agonist protocol with r-FSH alone or with r-LH supplementation when the leading follicle reached diameter of 14 mm. FF was collected at the time of oocyte retrieval from 32 follicles ≥ 18 mm. Serum FSH, LH, estradiol (E 2 ), and progesterone (P 4 ) were evaluated on the day of hCG administration. Intra-follicular E 2 , P 4 , AMH and TGF-β were assayed. Total RNA from 18 individual cumuli was isolated for gene expression analyses. Results R-LH increased FF P 4 levels. FF TGF-β levels and PTGS2 and HAS2 expression in cumulus cells (CCs) positively correlated with increased P 4 levels observed in FFs, while a negative correlation was found between P 4 and AMH levels. Conclusions FF positive correlation between P 4 and TGF-β levels and CC expression of PTGS2 and HAS2 suggest an association with a better follicle quality. In addition, our data suggest that late follicular phase r-LH supplementation leads to a more advanced stage of follicular maturation.

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“…Ancak sadece poor responder kadınları içeren çalışmalarda r-LH eklenmesiyle gebelik oranlarında anlamlı artış olduğunu göstermiştir. 25,27 Yine 2011 yılında Bosch ve ark.nın GnRH antagonist protokol uygulanan olgular üze-rinde yaptıkları çalışmada 36-39 yaş grubundaki olgularda r-LH eklenmesinin implantasyon oranını ve devam eden gebelik oranlarını artırdığı, 36 yaşın altındaki olguların LH desteğinden fayda görme-diklerini bildirmişlerdir. 28 Sonuç olarak, KOS'ta seçilmemiş olgularda r-LH eklenmesinin faydası olmadığı görülmektedir.…”

Section: Gonadotropi̇n Seçi̇mi̇unclassified

Controlled Ovarian Stimulation in IVF Cycles

Gürgan¹,

Gülerman²,

Özyer³

2017

TJRMS

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42n vitro fertilizasyon (IVF) sonrası ilk başarılı doğum, spontan ovulatuar siklusta tek bir oosit elde edilip tek embryo transferi yapılmasıyla sağlanmıştır. Ancak bu yöntemin başarı oranı dü-şüktür ve günümüzde klinisyenler çok sayıda follikülün senkron gelişimini sağlayacak ovaryan stimülasyon stratejilerinin kullanımını benimsemişlerdir. Kontrollü ovaryan stimülasyon (KOS), IVF tedavisi dahilinde overlerden en ideal sayı ve kalitede oosit elde etmek amacı ile aynı siklusta çok sayıda follikülün geliştirilmesidir. 1970'li yıllardaki ilk uygulamalardan itibaren KOS, IVF'in temel basamaklarından birini oluşturmaktadır. Oosit kalitesini ve canlı doğum oranlarını artırmak, düşük over rezervi olan hastalarda over yanıtını iyileştir-mek ve ovaryan hiperstimülasyon riskini azaltmak amacıyla çeşitli KOS protokolleri geliştirilmiştir. A An na ah h t ta ar r K Ke e l li i m me e l le er r: : İn vitro fertilizasyon; kontrollü ovaryan stimülasyon; protokol A AB BS S T TR RA AC CT T After the first live birth through a natural cycle in vitro fertilization (IVF) trial in 1978, advances in assisted reproductive techniques (ART) have been rapidly proceeded. Since then, more than 5 million pregnancies have been achieved worldwide by IVF and other modified techniques generally named as ART. As the experience and the success rates have increased, the indications for ART also expands. With the advances in reproductive biology, laboratory and pharmaceutical sciences, there is increasing attention on the importance of controlled ovarian stimulation (COS) to the IVF outcomes. Individualized COS (iCOS ) practices will improve IVF outcomes and safety issues. The aim of this review is to go through the fundamentals of COS and its best practices in ART.

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Recombinant human LH supplementation versus recombinant human FSH (rFSH) step-up protocol during controlled ovarian stimulation in normogonadotrophic women with initial inadequate ovarian response to rFSH. A multicentre, prospective, randomized controlled trial

Abstract: rLH supplementation is more effective than increasing the dose of rFSH in terms of ovarian outcome in patients with an initial inadequate ovarian response to rFSH alone.

Cited by 151 publications

References 20 publications

Improved pregnancy rates with luteinizing hormone supplementation in patients undergoing ovarian stimulation for IVF

Improved pregnancy rates with luteinizing hormone supplementation in patients undergoing ovarian stimulation for IVF

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

Controlled Ovarian Stimulation in IVF Cycles

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