Does exogenous LH supplementation improve reproductive outcome in poor responder women undergoing IVF/ICSI in GnRH antagonist protocol

Abstract

ObjectiveTo compare the efficacy of supplementing r-LH with r-FSH or only highly purified HMG or r-FSH alone in GnRH antagonist protocol, in improving the ovarian response and pregnancy rate in poor responder women undergoing IVF/ICSI.DesignA prospective observational study from October 2012 to September 2013.Materials and Methods126 poor responder women were included according to Bologna criteria (ESHRE 2010).These women received ovarian stimulation in a standard GnRH antagonist protocol and divided into three groups: Group I (n=34) received r-LH (75 IU/day) from the start of stimulation along with r-FSH (225 IU/day), group II (n=30) was stimulated with hp- HMG (300 IU/day) and group III (n=62) received r-FSH (300 IU/day). Primary outcome measure was clinical pregnancy rate. Secondary outcome was number of oocytes retrieved, implantation rate and ongoing pregnancy rate. Statistical analysis was performed using ANOVA for comparing continuous variables and Chi Square test for categorical variables. The statistical significance was evaluated by calculating the P value. A two-sided P-value < 0.05 was considered significant.ResultsTabled 1Reproductive outcome in poor responders undergoing IVF/ ICSI in GnRH antagonist protocolGroup I (N=34) r-LH + r-FSHGroup II (N=30) hp-HMGGroup III (N=62) r-FSHP ValueNo. of oocyte retrieved (Mean ±SD)3.32±1.273.17±1.463.85±1.380.057Implantation Rate(%)13.5(10/74)22.6(14/62)15.0(21/140)0.303Clinical Pregnancy Rate (%)26.5 (9/34)26.7 (8/30)30.6 (19/62)0.879Ongoing Pregnancy Rate (%)17.6 (6/34)20.0 (6/30)24.2 (15/62)0.738 Open table in a new tab ConclusionOur study and the available evidence so far do not demonstrate any beneficial effect of exogenous LH supplementation to the standard GnRH antagonist stimulation protocol in poor responder women undergoing IVF/ICSI. We have compared three different stimulation protocols but number of subjects was insufficient to demonstrate any significant difference. Further larger RCTs are required. ObjectiveTo compare the efficacy of supplementing r-LH with r-FSH or only highly purified HMG or r-FSH alone in GnRH antagonist protocol, in improving the ovarian response and pregnancy rate in poor responder women undergoing IVF/ICSI. To compare the efficacy of supplementing r-LH with r-FSH or only highly purified HMG or r-FSH alone in GnRH antagonist protocol, in improving the ovarian response and pregnancy rate in poor responder women undergoing IVF/ICSI. DesignA prospective observational study from October 2012 to September 2013. A prospective observational study from October 2012 to September 2013. Materials and Methods126 poor responder women were included according to Bologna criteria (ESHRE 2010).These women received ovarian stimulation in a standard GnRH antagonist protocol and divided into three groups: Group I (n=34) received r-LH (75 IU/day) from the start of stimulation along with r-FSH (225 IU/day), group II (n=30) was stimulated with hp- HMG (300 IU/day) and group III (n=62) received r-FSH (300 IU/day). Primary outcome measure was clinical pregnancy rate. Secondary outcome was number of oocytes retrieved, implantation rate and ongoing pregnancy rate. Statistical analysis was performed using ANOVA for comparing continuous variables and Chi Square test for categorical variables. The statistical significance was evaluated by calculating the P value. A two-sided P-value < 0.05 was considered significant. 126 poor responder women were included according to Bologna criteria (ESHRE 2010).These women received ovarian stimulation in a standard GnRH antagonist protocol and divided into three groups: Group I (n=34) received r-LH (75 IU/day) from the start of stimulation along with r-FSH (225 IU/day), group II (n=30) was stimulated with hp- HMG (300 IU/day) and group III (n=62) received r-FSH (300 IU/day). Primary outcome measure was clinical pregnancy rate. Secondary outcome was number of oocytes retrieved, implantation rate and ongoing pregnancy rate. Statistical analysis was performed using ANOVA for comparing continuous variables and Chi Square test for categorical variables. The statistical significance was evaluated by calculating the P value. A two-sided P-value < 0.05 was considered significant. ResultsTabled 1Reproductive outcome in poor responders undergoing IVF/ ICSI in GnRH antagonist protocolGroup I (N=34) r-LH + r-FSHGroup II (N=30) hp-HMGGroup III (N=62) r-FSHP ValueNo. of oocyte retrieved (Mean ±SD)3.32±1.273.17±1.463.85±1.380.057Implantation Rate(%)13.5(10/74)22.6(14/62)15.0(21/140)0.303Clinical Pregnancy Rate (%)26.5 (9/34)26.7 (8/30)30.6 (19/62)0.879Ongoing Pregnancy Rate (%)17.6 (6/34)20.0 (6/30)24.2 (15/62)0.738 Open table in a new tab ConclusionOur study and the available evidence so far do not demonstrate any beneficial effect of exogenous LH supplementation to the standard GnRH antagonist stimulation protocol in poor responder women undergoing IVF/ICSI. We have compared three different stimulation protocols but number of subjects was insufficient to demonstrate any significant difference. Further larger RCTs are required. Our study and the available evidence so far do not demonstrate any beneficial effect of exogenous LH supplementation to the standard GnRH antagonist stimulation protocol in poor responder women undergoing IVF/ICSI. We have compared three different stimulation protocols but number of subjects was insufficient to demonstrate any significant difference. Further larger RCTs are required.