Abstract
To investigate whether patients with a previous recombinant follicle stimulating hormone (rFSH)-stimulated cycle would have improved outcomes with rFSH + recombinant luteinizing hormone (rLH) stimulation in the following cycle. For the present retrospective case-control study, 228 cycles performed in 114 patients undergoing intracytoplasmic sperm injection (ICSI) between 2015 and 2018 in an in vitro fertilization (IVF) center were evaluated. Controlled ovarian stimulation (COS) was achieved with rFSH (Gonal-f, Serono, Geneva, Switzerland) in the first ICSI cycle (rFSH group), and with rFSH and rLH (Pergoveris, Merck Serono S.p.A, Bari, Italy) in the second cycle (rFSH + rLH group). The ICSI outcomes were compared among the groups. Higher estradiol levels, oocyte yield, day-3 high-quality embryos rate and implantation rate, and a lower miscarriage rate were observed in the rFSH + rLH group compared with the rFSH group. In patients < 35 years old, the implantation rate was higher in the rFSH + rLH group compared with the rFSH group. In patients ≥ 35 years old, higher estradiol levels, oocyte yield, day-3 high-quality embryos rate, and implantation rate were observed in the rFSH + rLH group. In patients with ≤ 4 retrieved oocytes, oocyte yield, mature oocytes rate, normal cleavage speed, implantation rate, and miscarriage rate were improved in the rFSH + rLH group. In patients with ≥ 5 retrieved oocytes, higher estradiol levels, oocyte yield, and implantation rate were observed in the rFSH + rLH group. Ovarian stimulation with luteinizing hormone (LH) supplementation results in higher implantation rates, independent of maternal age and response to COS when compared with previous cycles stimulated with rFSH only. Improvements were also observed for ICSI outcomes and miscarriage after stratification by age and retrieved oocytes.
Highlights
For assisted reproductive technology (ART), gonadotropinreleasing hormone (GnRH) and gonadotropins are routinely administered for controlled ovarian stimulation (COS)
Higher estradiol levels, oocyte yield, day-3 high-quality embryos rate and implantation rate, and a lower miscarriage rate were observed in the recombinant follicle stimulating hormone (rFSH) þ recombinant luteinizing hormone (rLH) group compared with the rFSH group
Ovarian stimulation with luteinizing hormone (LH) supplementation results in higher implantation rates, independent of maternal age and response to COS when compared with previous cycles stimulated with rFSH only
Summary
For assisted reproductive technology (ART), gonadotropinreleasing hormone (GnRH) and gonadotropins are routinely administered for controlled ovarian stimulation (COS). Follicle stimulating hormone and LH play distinct but complementary roles in follicle regulation, leading to synergistic actions in stimulating the recruitment and development of ovarian follicles, increasing follicle estradiol secretion, and completing oocyte maturation and subsequent ovulation.[1]. Recruited follicles are radically deprived of LH sustenance. Exogenous FSH stimulation will support follicular development in most patients undergoing ART; up to 12% of the patients will not respond to FSH stimulation alone, which can happen due to the absence of LH.[3] For this subpopulation of patients, there is evidence that LH supplementation to FSH administration could be advantageous.[3,4,5,6,7,8,9,10]
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