Does day 3 luteinizing-hormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues?

ABSTRACT The role of follicle stimulating hormone (FSH) in assisted reproductive technology is well understood, though there is still no published consensus on the need for exogenous luteinizing hormone (LH) in controlled ovarian stimulation. There is a dilemma regarding the usefulness of LH supplementation in controlled ovarian stimulation despite growing understanding of the LH and FSH interrelation and their effects on fertilization and implantation. This review revisits the physiological role of LH, LH receptors and the concept of LH therapeutic window. With the availability of LH activity from different sources, there is a need to understand the differences between recombinant human LH (r-HLH), human menopausal gonadotropin and human chorionic gonadotropin (hCG). It has been observed that adjuvant r-HLH provides precise control over the dose of LH bioactivity administered to target the therapeutic window. This review discusses about the various patient subgroups that may benefit from LH supplementation. The use of r-HLH is recommended in women with poor response in a previous cycle or suboptimal follicular growth in an ongoing ovarian stimulation cycle by day 6 to 8 of stimulation. Exogenous LH administration should also be considered in women at risk of suboptimal response, specifically age > 35 years and women treated with GnRH analogues (agonists or antagonists) during ovarian stimulation causing over suppression of endogenous LH and FSH pituitary secretion. Further research is needed to identify LH polymorphisms, adequate dosing, cost efficacy, need for rLH and hCG supplementation in different patient profiles for maximum benefit during controlled ovarian stimulating (COS). How to cite this article Vohra A, Rao KA. Luteinizing Hormone in Controlled Ovarian Stimulation. Int J Infertil Fetal Med 2014; 5(3):75-86.

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Follicle-Stimulating Hormone/Luteinizing Hormone Ratio as an Independent Predictor of Response to Controlled Ovarian Stimulation

Women s Health ◽

10.2217/whe.14.31 ◽

2014 ◽

Vol 10 (5) ◽

pp. 505-509 ◽

Cited By ~ 2

Author(s):

Jason D Kofinas ◽

Rony T Elias

Keyword(s):

Luteinizing Hormone ◽

Ovarian Stimulation ◽

Independent Predictor ◽

Follicle Stimulating Hormone ◽

Controlled Ovarian Stimulation ◽

Stimulating Hormone

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Oral contraceptive pretreatment in women undergoing controlled ovarian stimulation in ganirelix acetate cycles may, for a subset of patients, be associated with low serum luteinizing hormone levels, reduced ovarian response to gonadotropins, and early pregnancy loss

Fertility and Sterility ◽

10.1016/j.fertnstert.2008.01.007 ◽

2009 ◽

Vol 91 (5) ◽

pp. 1963-1965 ◽

Cited By ~ 15

Author(s):

David R. Meldrum ◽

Richard T. Scott Jr. ◽

Michael J. Levy ◽

Michael M. Alper ◽

Nicole Noyes

Keyword(s):

Oral Contraceptive ◽

Luteinizing Hormone ◽

Early Pregnancy ◽

Ovarian Stimulation ◽

Pregnancy Loss ◽

Ovarian Response ◽

Controlled Ovarian Stimulation ◽

Early Pregnancy Loss ◽

Serum Luteinizing Hormone ◽

Low Serum

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The ratio of exogenous Luteinizing hormone to Follicle stimulating hormone administered for controlled ovarian stimulation is associated with oocytes’ number and competence

Bioscience Reports ◽

10.1042/bsr20190811 ◽

2020 ◽

Vol 40 (1) ◽

Author(s):

Dragos Albu ◽

Alice Albu

Keyword(s):

Luteinizing Hormone ◽

Ovarian Stimulation ◽

Follicle Stimulating Hormone ◽

Fertilization Rate ◽

Controlled Ovarian Stimulation ◽

Human Menopausal Gonadotropin ◽

Male Factor ◽

Entire Study ◽

Stimulating Hormone

Abstract We performed a retrospective study aiming to study the relationship between the ratio of the exogenous luteinizing hormone to follicle stimulating hormone (LH/FSH) administrated for controlled ovarian stimulation (COS) and the number and competence of the oocytes retrieved for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Eight hundred sixty-eight consecutive infertile patients (mean age 34.54 ± 4.01 years, mean anti-Müllerian hormone (AMH) 2.94 ± 2.07 ng/ml) treated with long agonist protocol and a mixed gonadotropin protocol (human menopausal gonadotropin in association with recombinant FSH (recFSH)) who performed IVF/ICSI between January 2013 and February 2016, were included. Patients with severe male factor were excluded. LH/FSH was calculated based on total doses of the two gonadotropins. We found, after adjustment for confounders, a positive relationship between LH/FSH and the retrieved oocytes’ (β = 0.229, P<0.0001) and zygotes’ number (β = 0.144, P<0.0001) in the entire study group and in subgroups according to age (<35 and ≥35 years) and ovarian reserve (AMH < 1.1 and ≥ 1.1 ng/ml). The fertilization rate was positively associated with LH/FSH in patients with LH/FSH in the lowest three quartiles (below 0.77) (β = 0.096, P=0.034). However, patients in the fourth quartile of LH/FSH had a lower fertilization rate as compared with patients in quartiles 1–3 which, after adjustment for covariates, was only marginally negatively related with LH/FSH (β = −0.108, P=0.05). In conclusion, our results suggest that the adequate LH/FSH administrated during COS can improve the oocytes’ and zygotes’ number in IVF/ICSI cycles, but also the fertilization rate when a certain proportion of LH/FSH is not exceeded.

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Antral follicle count and anti-Müllerian hormone level as predictors of ovarian hyperstimulation syndrome in women with polycystic ovarian syndrome undergoing controlled ovarian stimulation

Journal of Ultrasonography ◽

10.15557/jou.2021.0032 ◽

2021 ◽

Vol 21 (86) ◽

pp. e200-e205

Author(s):

Rubina Izhar ◽

◽

Samia Husain ◽

Muhammad Ahmad Tahir ◽

Mauzma Kausar ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Ovarian Stimulation ◽

Ovarian Hyperstimulation Syndrome ◽

Polycystic Ovarian Syndrome ◽

Hormone Level ◽

Antral Follicle ◽

Antral Follicle Count ◽

Controlled Ovarian Stimulation ◽

Ovarian Hyperstimulation ◽

Ovarian Syndrome

Aim: To compare the rate of ovarian hyperstimulation syndrome in women with and without polycystic ovarian syndrome, and to determine the cut-off for the antral follicle count and the anti-Müllerian hormone level predictive of ovarian hyperstimulation syndrome in both groups. Methods: This was a prospective cohort study conducted in women aged 20–35 years who were undergoing controlled ovarian stimulation. The women were divided into those with polycystic ovarian syndrome and the controls on the basis of the Rotterdam criteria. The outcome of stimulation was recorded, and the ovarian response markers were compared in both groups. Results: Among 689 women included in the study, 276 (40.1%) had polycystic ovarian syndrome, and 476 (59.9%) were used as the controls. Ovarian hyperstimulation syndrome occurred in 19.6% of the cases, and in 7.7% of the controls (p <0.001). The conception rate was greater in the group of cases (52.5% vs. 16.5%, p = 0.001). Among the cases, the sensitivity and specificity for the prediction of hyper-response were 94.4% and 97.3% for AFC, and 92.6% and 93.7% for the anti-Müllerian hormone, at the cut-off values of ≥18 and ≥6.425 ng/ml, respectively. Among the controls, the sensitivity and specificity for the prediction of hyper-response were 93.8% and 97.1% for the antral follicle count, and 93.6% and 94.5% for the anti-Müllerian hormone, at the cut-off values of ≥10 and ≥3.95 ng/ml, respectively. Conclusion: Group-specific values should be used to identify and counsel women undergoing controlled ovarian stimulation. In light of available evidence, gynaecologists should be trained to perform ultrasound evaluation, determine the antral follicle count of their patients, and offer them appropriate counselling.

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