Recombinant LH supplementation during IVF cycles with a GnRH-antagonist in estimated poor responders: A cross-matched
pilot investigation of the optimal daily dose and timing

Gizzo,Salvatore; Andrisani,Alessandra; Noventa,Marco; Manfè,Serena; Oliva,Alessandra; Gangemi,Michele; Nardelli,Giovanni Battista; Ambrosini,Guido

doi:10.3892/mmr.2015.3904

Recombinant LH supplementation during IVF cycles with a GnRH-antagonist in estimated poor responders: A cross-matched pilot investigation of the optimal daily dose and timing

Authors:
- Salvatore Gizzo
- Alessandra Andrisani
- Marco Noventa
- Serena Manfè
- Alessandra Oliva
- Michele Gangemi
- Giovanni Battista Nardelli
- Guido Ambrosini
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Affiliations: Department of Women's and Children's Health, Assisted Reproductive Unit of the Gynecological and Obstetrics Clinic, University of Padua, I-35128 Padua, Italy
Published online on: June 9, 2015 https://doi.org/10.3892/mmr.2015.3904
Pages: 4219-4229
Copyright: © Gizzo et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

Although it is widely accepted that patients, who are considered poor responders to in vitro fertilization (IVF) benefit from recombinant luteinizing hormone (rLH) supplementation during an in vitro fertilization cycle, particularly when gonadotropin‑releasing hormone (GnRH)‑antagonist (ant) treatment is used the optimal administration timing and daily dose of rLH remains to be elucidated. The aim of the present study was to investigate the optimal timing of rLH‑supplementation to improve ovarian response, embryo quality, endometrial thickness and pregnancy rate in infertile, estimated poor responders to IVF, undergoing GnRH‑ant treatment. In addition, the present study aimed to evaluate the optimal daily dose to achieve the same outcomes. A prospective‑randomized‑cross‑matched investigation was performed on 40 patients undergoing a GnRH‑ant‑treatment‑cycle The patients were randomly assigned to either group A (rLH‑75 IU/day) or group B (rLH‑150 IU/day) and further randomized into subgroup A1/B1, in which rLH was administered at recombinant follicle stimulating hormone (rFSH) administration, and subgroup A2/B2, in which rLH was administered at GnRH‑ant administration. Patients who did not become pregnant during the first cycle (35 patients), were treated a second time, cross‑matched for groups and subgroups. Improved ovarian response, embryo quality and pregnancy rate were achieved by administering rLH at 150 IU/day, starting from GnRH‑ant administration, independently from the total rLH dose administered. Improved endometrial thickness at oocyte retrieval day was achieved by administering rLH at 150 IU from the start of rFSH administration. These data led to the hypothesis that ovarian responses are affected by the timing of administration more than the total‑dose of rLH. The optimal window to administer rLH appears to be the mid‑to‑late follicular phase, despite the fact that rLH‑supplementation in the early‑follicular phase appeared to increase endometrial thickness and to enhance its morphology. Standardization of the optimal daily dose and supplementation timing of rLH may resolve the debate regarding its efficacy in increasing the number of pregnancies and neonatal survival rates.

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