To evaluate the effect of recombinant LH in assisted reproduction technology (ART) cycles in patients of advanced reproductive age.
A systematic review and meta-analysis.
Published randomized controlled clinical trials comparing recombinant LH plus recombinant FSH versus recombinant FSH only in patients of advanced reproductive age.
Patients 35 years and older undergoing assisted reproduction.
Recombinant LH plus recombinant FSH controlled ovarian hyperstimulation (COH) versus recombinant FSH stimulation only in assisted reproduction cycles.
Implantation and clinical pregnancy.
Seven trials were identified that met inclusion criteria and comprised 902 assisted reproduction technology cycles. No differences in serum E(2) on the day of hCG administration were reported in any trials. Two trials reported lower oocyte yield and one trial reported lower metaphase II oocyte yield in the recombinant LH-supplemented group. One trial reported higher fertilization rates in the recombinant LH-supplemented group. In a fixed effect model, implantation was higher in the recombinant LH-supplemented group (odds ratio 1.36, 95% confidence interval 1.05-1.78). Similarly, clinical pregnancy was increased in the recombinant LH-supplemented group (odds ratio 1.37, 95% confidence interval 1.03-1.83).
The addition of recombinant LH to ART cycles may improve implantation and clinical pregnancy in patients of advanced reproductive age.
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"Although these findings should be interpreted with caution (as the primary end-point was not met and the study was not powered to make conclusions about secondary end-points), further investigation in a larger sample using clinical pregnancy, live birth or both, as end-points would be of great interest. The meta-analysis reported by Hill et al. (2012) found LH supplementation to be associated with higher rates of implantation and clinical pregnancy in women aged ≥35 years undergoing ovarian stimulation for assisted reproduction techniques compared with those receiving rhFSH alone; however, that study did not explore the optimal day to initiate LH during ovarian stimulation. Published evidence suggesting that high levels of LH can lead to follicular atresia and spontaneous abortion (Howles et al., 1986; Stanger and Yovich, 1985) has led to the concept of a 'therapeutic window' for LH to stimulate optimal oestradiol production and promote success in assisted reproduction techniques and ovulation induction (Kumar and Sait, 2011; Shoham, 2002). "
"years of age (Kolibianakis et al., 2007). Conversely, recent systematic reviews of r-LH supplementation in any women undergoing IVF have suggested that r-FSH/ r-LH improves the clinical pregnancy rate compared with r-FSH overall (risk ratio [RR] 1.09; 95% CI 1.01– 1.18) (Lehert et al., 2014), in women aged ≥35 years (OR 1.37, 95% CI 1.03 –1.83) (Hill et al., 2012) and in those with poor ovarian response (OR 1.3, 95% CI 1.05 –1.62) (Lehert et al., 2014). Some individual studies have also reported results that conflict with those of the current study in women aged ≥35 years (Humaidan et al., 2004; Matorras et al., 2009). "
"Some authors suggested the addition of recombinant LH during gonadotropin stimulation in poor responder patients . However, two meta-analyses [81, 82] showed that the addition of recombinant LH does not increase the number of oocyte retrieved, the total dose of FSH, the cancellation rates, and the ongoing pregnancy rates in poor responder patients. "
[Show abstract][Hide abstract] ABSTRACT: Despite the fact that in the last two decades an enormous number of papers on the topic of poor ovarian response have been published in the literature, so far it has been impossible to identify any efficient treatment to improve the ovarian response and the clinical outcome of this group of patients. The incidence of poor ovarian responders among infertile women has been estimated at 9-24% but according to recent reviews, it seems to have slightly increased. The limitation in quantifying the incidence of these patients among the infertile population is due to the difficulty of a clear definition in literature. A recent paper by the Bologna ESHRE working group on poor ovarian response has been the first real attempt to find a common definition. Current literature proposes new risk factors which could be the cause of a reduction in ovarian reserve, which also includes genetic factors. This represents the first necessary step towards finding applicable solutions for these patients. To date, there is a substantial lack of literature that identifies an ideal protocol for these patients. The use of the "Bologna criteria" and the introduction of long acting gonadotropin in clinical practice have given rise to new promising stimulation protocols for this group of patients.
Full-text · Article · Jul 2014 · BioMed Research International