Serum luteinizing hormone, follicle-stimulating hormone and oestradiol pattern in women undergoing pituitary suppression with different gonadotrophin-releasing hormone analogue protocols for assisted reproduction

Abstract

Gonadotrophin-releasing hormone analogues (GnRH-a) are used widely in controlled ovarian stimulation (COS) cycles for assisted reproduction. At present, there is great debate about the influence of exogenous hormone activity on the hypothalamus-pituitary axis following pituitary desensitization. The objective of this comparative study was to investigate the pattern of luteinizing hormone (LH), follicle-stimulating hormone (FSH) and oestradiol in women undergoing ovarian stimulation with different GnRH-a preparations. We retrospectively analysed 201 women, aged between 27 and 43 years, who were referred consecutively to our infertility clinic between January 2002 and January 2003. All women had no endocrinopathies or occult ovarian failure as assessed by day-3 hormone profile. Women were enrolled in one of the following COS protocols: depot triptorelin long protocol (n = 38), buserelin long protocol (n = 101) or buserelin short protocol (n = 62). Recombinant FSH was used to induce ovulation. Treatment was monitored by transvaginal ultrasound scan and serum measurement of FSH, LH and oestradiol. Among the women initially included, 30 had cancelled cycles due to poor ovarian response. Serum LH levels were significantly higher in the short-protocol group compared with the long-protocol groups (p < 0.001). The number of follicles, oocyte yield, number of grade-I embryos and fertilization rate were significantly lower in the short-protocol group than in the long-protocol groups. These findings showed that LH concentrations are significantly higher in women undergoing reversible medical hypophysectomy with a GnRH-a short protocol than in women treated with a long protocol. The hypothesis of an LH ceiling is confirmed.

The impact of LH-containing gonadotropin stimulation on euploidy rates in preimplantation embryos: antagonist cycles

“…The concept of an appropriate LH concentration for euploidy, pregnancy, and miscarriage that is supported by our data and by others (4,6,25), reemphasizes the need for individualized ovarian stimulation and their careful, stratified analysis. Because even apparently small changes in protocol may have profound, and possibly contradictory, consequences, significant effects may balance each other out, and, therefore, be overlooked in nonstratified patient populations.…”

“…Fuel to this controversy was added by the concept of ''LH ceiling levels,'' a yet-to-be-defined serum LH concentration above which LH is believed to cause detrimental effects on oocyte development and implantation (6).…”

GnRH signaling, the gonadotrope and endocrine control of fertility

“…Downregulation of gonadotrope responsiveness to GnRH through continuous hormone exposure effectively uncouples the gonads from pituitary regulation, allowing for precise clinical manipulation of germ cell maturation through the administration of exogenous gonadotropins. This general strategy forms the basis for the clinical use of GnRH analogs that are prescribed for the treatment of many forms of infertility, especially in females [169;236]. …”

Recombinant human luteinizing hormone supplementation may improve embryo quality in in vitro fertilization/intracytoplasmic sperm injection cycles with gonadotropin-releasing hormone antagonist protocol

“…Despite the vast experience in various in vitro fertilization (IVF) protocols, the beneficial effect of LH supplementation during ovarian stimulation is still far from clear [1]. This controversy is supported by the theory of "LH ceiling levels," a yet-to-be-defined serum LH concentration, above which LH is believed to cause detri-mental effects on oocyte development and implantation [2].…”