Suppression of LH during ovarian stimulation: effects differ in cycles stimulated with purified urinary FSH and recombinant FSH

Abstract

There has been much debate about the role of luteinizing hormone (LH) during follicle stimulating hormone (FSH)-treated ovarian stimulation for assisted reproduction, where the endogenous LH is suppressed using a gonadotrophin-releasing hormone analogue. The requirement for LH in oestradiol biosynthesis is established, but other effects of 'insufficiency' are less clear, and little attention has been paid to the specific origin of the FSH used. The aim of this study was to examine the roles of profoundly suppressed circulating LH concentrations in cycles of ovarian stimulation for IVF, which were affected in two large separate cohorts of patients undergoing assisted reproduction. They were stimulated by either purified urinary FSH (MHP) or recombinant human FSH (rFSH). Within each dataset, outcomes were examined with respect to the circulating concentrations of LH in the mid-follicular phase, as plasma samples were stored prospectively, and assayed retrospectively. Patients with profoundly suppressed LH showed much reduced oestradiol concentrations at mid-follicular phase and at human chorionic gonadotrophin administration in cycles treated with either MHP or rFSH. However, gross ovarian response, as became evident by FSH dose demands, duration of stimulation, and also oocyte and embryo yields and embryo cryopreservation were influenced only in cycles treated with MHP. Furthermore, no effect upon pregnancy survival was observed. Thus, it is concluded that there is a demand for additional exogenous LH treatment only in cycles treated with purified urinary FSH where the LH is profoundly suppressed.

Antimüllerian hormone and pituitary gland activity after prolonged down-regulation with goserelin acetate

“…If these patients were to proceed to assisted conception treatment, poor ovarian performance and low E 2 production would be expected unless exogenous LH is added during stimulation. It has been suggested that adding exogenous LH to such patients would improve ovarian response and optimize steroidogenesis (20,21). It may be worth considering in such patients to proceed with daily buserelin instead of exogenous LH, which may increase the endogenously secreted LH levels, as shown in this study.…”

Efficacy of a combined protocol of urinary and recombinant follicle-stimulating hormone used for ovarian stimulation of patients undergoing ICSI cycle

“…On the other hand, other studies have shown that a low concentration of endogenous LH (<3 mIU/ml) in the late follicular phase is associated with lower fertilization rates and higher biochemical pregnancy rates. It has been suggested that when using recombinant FSH only, it may be of clinical benefit to add LH in the late follicular phase or to further reduce the dose of GnRH analogue [33][34][35][36]. Conversely, it has been reported that patients with very suppressed LH levels respond similarly to those moderately suppressed, and only 6% of patients would benefit from exogenous LH administration [32].…”

Gonadotropin in Assisted Reproduction: An Evolution Perspective

“…In summary, evidence indicates that a subset of women has less responsive ovaries to COS explained by a variety of factors, including reduced paracrine ovarian activity [153], LH receptor polymorphisms [152], reduced androgen secretory capacity [154], decreased number of functional LH receptors [155], and reduced LH bioactivity while LH imnunoreactivity is unchanged [156,157]. Thus, it has been hypothesized that the aforementioned women would benefit from the use of LH-containing gonadotropin preparations [144,146,150,158,159].…”