Abstract
ObjectiveLuteinizing hormone (LH) and human chorionic gonadotropin (hCG) activate distinct intracellular signaling cascades. However, due to their similar structure and common receptor, they are used interchangeably during ovarian stimulation (OS). This study aims to assess if the source of LH used during OS affects IVF outcome.Patients and methodsThis was a cross sectional study of patients who underwent two consecutive IVF cycles, one included recombinant follicular stimulating hormone (FSH) plus recombinant LH [rFSH+rLH, (Pergoveris)] and the other included urinary hCG [highly purified hMG (HP-hMG), (Menopur)]. The OS protocol, except of the LH preparation, was identical in the two IVF cycles.ResultsThe rate of mature oocytes was not different between the treatment cycles (0.9 in the rFSH+rLH vs 0.8 in the HP-hMG, p = 0.07). Nonetheless, the mean number of mature oocytes retrieved in the rFSH+rLH treatment cycles was higher compared to the HP-hMG treatment cycles (10 ± 5.8 vs 8.3 ± 4.6, respectively, P = 0.01). Likewise, the mean number of fertilized oocytes was higher in the rFSH+rLH cycles compared with the HP-hMG cycles (8.5 ± 5.9 vs 6.4 ± 3.6, respectively, p = 0.05). There was no difference between the treatment cycles regarding the number of top-quality embryos, the ratio of top-quality embryos per number of oocytes retrieved or fertilized oocytes or the pregnancy rate.ConclusionThe differences in treatment outcome, derived by different LH preparations reflect the distinct physiological role of these molecules. Our findings may assist in tailoring a specific gonadotropin regimen when assembling an OS protocol.
Highlights
Ovarian stimulation (OS) is a fundamental step in the process of artificial reproductive technology (ART)
The mean number of mature oocytes retrieved in the recombinant FSH (rFSH)+rLH treatment cycles was higher compared to the HP-human menopausal gonadotropin (hMG) treatment cycles (10 ± 5.8 vs 8.3 ± 4.6, respectively, P = 0.01)
The mean number of fertilized oocytes was higher in the rFSH+rLH cycles compared with the highly purified- hMG (HP-hMG) cycles (8.5 ± 5.9 vs 6.4 ± 3.6, respectively, p = 0.05)
Summary
Ovarian stimulation (OS) is a fundamental step in the process of artificial reproductive technology (ART). Administration of exogenous gonadotropins enables the recruitment and development of multiple follicles, in order to yield an optimal number of mature oocytes The action of both Follicular stimulating hormone (FSH) and luteinizing hormone (LH) is required for follicular growth [1]. Improvement in purification techniques enabled the development of highly purified- hMG (HP-hMG) containing 1:1 ratio of FSH and LH bioactivity that is predominantly derived from hCG, since LH molecules are lost during the purification process. Another source of commercial gonadotropin is recombinant gonadotropin preparations. These include recombinant FSH (rFSH), rLH, rhCG and combined product of rFSH and rLH in a 2:1 ratio [4]
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