Adding luteinizing hormone to follicle stimulating hormone from day 3-5 improves pregnancy outcome in normal but not poor responders using gonadotropin releasing hormone antagonists

Abstract

The objective was to determine if adding luteinizing hormone (LH) to follicle stimulating hormone (FSH) stimulation from day 3-5 would effect pregnancy and/or implantation rates when using a gonadotropin releasing hormone (GnRH) antagonist. The study would also evaluate the confounding effect of age and ovarian oocyte reserve. Retrospective cohort analysis of in vitro fertilization-embryo transfer IVF-ET). The parameters compared were clinical (ultrasound evidence of pregnancy at 8 weeks), viable (live at 12 weeks) and live delivered pregnancy rates (PRs). The data were stratified according to two age groups - <39.9 and 40-42, and whether they were normal responders (>5 eggs retrieved) or poor responders (<4 eggs retrieved). LH % varied from 25-50% of the total FSH. Women with elevated day 3 serum FSH used lower dosages of FSH. The choice of all FSH or LH/FSH was based on physician and/or patient preference. Comparisons were made by chi-square analysis. For all ages and for normal and poor responders combined the clinical PR/transfer was 33.4% (248/743) for women receiving all FSH for COH vs. 39.7% (423/1066) when LH was added (P=.007). The viable PRs were 28.3% vs. 35.5% (P=0.0016) and the live delivered PRs were 25.8% vs. 32.3% (P=0.0038). Evaluating separately the poor responders, the clinical, viable, and live delivered PRs for the all FSH group was 25.5% (103/404), 20.5% (83/404), and 17.8% (72/404) vs. 26.4% (60/227), 22.5% (51/227), and 20.3% (16/227) for LH/FSH group (chi-square analysis, P=NS). Addition of LH to FSH improves pregnancy rates in normal responders using a traditional high dose FSH COH protocol with a GnRH antagonist. Using mild stimulation for women with diminished ovarian reserve adding LH does not seem to matter.