A prospective, randomized comparison of ovulation induction using highly purified follicle-stimulating hormone alone and with recombinant human luteinizing hormone in in-vitro fertilization

• Published in: Human reproduction (Oxford) Vol. 14; no. 9; pp. 2230 - 2235
• Main Authors: Sills, E.Scott, Levy, Delphine P., Moomjy, Maureen, McGee, Monnie, Rosenwaks, Zev
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.1999
• Subjects: Adult; Biological and medical sciences; Embryo Implantation; Female; Fertilization in Vitro; Follicle Stimulating Hormone - administration & dosage; Follicle Stimulating Hormone - therapeutic use; FSH; Genital system. Reproduction; Humans; IVF; Luteinizing Hormone - administration & dosage; Luteinizing Hormone - therapeutic use; Medical sciences; ovulation induction; Ovulation Induction - methods; Pharmacology. Drug treatments; Pregnancy; Prospective Studies; recombinant human luteinizing hormone; Recombinant Proteins - administration & dosage; Recombinant Proteins - therapeutic use; IVF; FSH; ovulation induction; recombinant human luteinizing hormone; Human; Drug combination; Ovulation inducer; Assisted procreation; Gonadotropin; Ovulation; In vitro fertilization embryo transfer; Adenohypophyseal hormone; Luteinizing hormone; Drug interaction; Recombinant protein; Woman; Follicle stimulating hormone
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/14.9.2230

The commercial availability of highly purified, s.c. administered urinary follicle stimulating hormone (FSH) preparations for ovarian stimulation marked the beginning of a new era in the treatment of infertility. As these new formulations contain essentially no luteinizing hormone (LH), supplemental LH may be needed for optimal folliculogenesis. It was the aim of this pilot study to compare fertilization rates, embryo morphology, implantation rates and pregnancy outcomes prospectively in two age-matched patient groups: women who received highly purified FSH (FSH-HP) (n = 17), and women who received FSH-HP plus recombinant human LH (rhLH, n = 14) throughout ovarian stimulation. All patients received mid-luteal pituitary down-regulation with s.c. gonadotrophin-releasing hormone agonist (GnRHa) (leuprolide). Mean implantation rates were 26.9 and 11.9% in the FSH-HP only and FSH-HP + rhLH groups respectively. The mean clinical pregnancy/initiated cycle rate was 64.7 and 35.7% for the FSH-HP only and FSH-HP + rhLH patients respectively. FSH-HP patients and FSH-HP + rhLH patients achieved clinical pregnancy/transfer rates of 68.8 and 45.5% respectively. One patient in the FSH-HP + rhLH group had a spontaneous abortion; no pregnancy losses occurred in the FSH-HP only group. There were more cancellations for poor ovarian response among FSH-HP + rhLH patients (n = 3) than among FSH-HP patients (n = 1). The trend toward better pregnancy outcomes among patients who received FSH-HP without supplemental rhLH did not reach statistical significance. It is postulated that appropriate endogenous LH concentrations exist despite luteal GnRHa pituitary suppression, thereby obviating the need for supplemental LH administration.