#162 : Effect of r-LH Supplementation in Controlled Ovarian Stimulation in Antagonist Protocol of IVF

Abstract

Background and Aims: Adding LH to FSH can increase the mean of retrieved oocytes and cumulative embryos. LH stimulates the theca cells to secrete androgens, which are converted to estrogens during folliculogenesis. Women with long GnRH agonist downregulation, GnRH antagonist protocol, poor ovarian reserve, and patients with hypogonadotropic hypogonadism may have advantages in using exogenous LH. Here we show our experience using r-LH in our clinic concerning oocyte retrieval and maturity rates. Methods: We retrospectively took data from patients who underwent antagonist protocol from January 2021- January 2023 in Mbrio IVF Clinic Jakarta. Forty-three patients were stimulated by r-FSH (n=9) and a combination of r-FSH and r-LH (co-treatment) (n = 34) for 9-11 days and triggered by r-HCG or dual trigger (r-HCG and GnRHa). We statistically analyzed the retrieval rate, maturation rate, and OSI (ovarian sensitivity index) by independent-T and Mann-Whitney U tests. The level of significance was set at p < 0.05. Results: The mean age (33 vs. 35 yo), estrogen level, and trigger treatment were similar in both groups. The median AMH level in group r-FSH was higher than the co-treatment group (p 0.012; 4.44 vs. 1.75). The median retrieval and mean maturation rates were equivalent in both groups (100% vs. 90.9%; 78.5% vs. 80%). The OSI was higher in r-FSH than the second group but statistically insignificant. (p 0.20; 5.42 vs. 3.29). Conclusions: Adding LH to FSH in antagonist protocol gives both groups the same retrieval and maturity rate. Although they had comparable OSI, the AMH level in the co-treatment was lower than in the first group. The lower AMH level group gets advantages from the co-treatment in this data. We need larger data and complex analysis to validate the result.