A cohort study of both human menopausal gonadotropin (HMG) and recombinant luteinizing hormone addition at early follicular stage in in vitro fertilization outcome

Abstract

At present, the precise role of human menopausal gonadotropin (HMG) and recombinant luteinizing hormone (rLH) supplementation at an early time of follicular phase on in vitro fertilization (IVF)/intra cytoplasmatic sperm injection (ICSI) outcomes remains uncertain. Here infertile women of normal ovarian function undergoing their first cycle of IVF/ICSI were studied and were randomly allocated into 3 groups. Group 1, ovarian stimulation with 150IU recombinant follicle-stimulating hormone (FSH) alone. Group 2, patients received 75IU rFSH and 75IU HMG. Group 3 patients were given 150IU rFSH and 75IU rLH. There were no significant differences in the clinical characteristics, ovarian response, the biochemical, clinical and ongoing pregnancy rates among the 3 groups. No significant differences were found in biochemical, clinical and ongoing pregnancy rates between the patients whose LH levels were lower than 0.75 mIU/ml and those above this threshold in group 1. Furthermore, there were also no significant differences in biochemical, clinical and ongoing pregnancy rates among the 3 group patients whose LH level lower than 0.75 mIU/ml. The results showed that either the addition of HMG or rLH supplementation at an early time of follicular phase produce no significant benefit on IVF outcome in patients with normal ovarian function.

rLH/rFSH Combination Improved Cumulative Live Birth Rate in Patients With LH Over-Suppression Following GnRH Agonist Pituitary Down-Regulation Compared to rFSH or hMG Alone: A Retrospective Cohort Study With Propensity Score Matching

“…A previous study obtained a similar conclusion in women > 35 y [26]; the ongoing pregnancy rate was higher in an rFSH + rLH group than that in an hMG group (17.3% vs. 12.2%). However, in another study, the supplementation of LH did not show any signi cant improvement in clinical outcomes [27]. There should be differences in effectiveness between HCG and rLH based on their mechanism of action, thus we propose that the inconsistency of the effectiveness of rLH supplementation is related to the extent of decrease in LH.…”

HMG versus recombinant FSH plus recombinant LH in ovarian stimulation for IVF: does the source of LH preparation matter?

“…The search yielded 11 articles, of which three were prospective trials (Pacchiarotti et al, 2010;Requena et al, 2014;Tehraninejad et al, 2017): two were randomized controlled trials (Pacchiarotti et al, 2010;Tehraninejad et al, 2017) and one was a prospective observational study, in which patients were assigned to each treatment group based on a quasi-experimental design comprising consecutive opportunity sampling (Requena et al, 2014). Eight retrospective studies were found (Buhler and Fischer, 2012;Fábregues et al, 2013;Dahan et al, 2014;Revelli et al, 2015;Schwarze et al, 2016;Bleau et al, 2017;Renzini et al, 2017;Xia et al, 2019). The characteristics of all the studies are presented in TABLE 1.…”

“…The studies used different ovarian stimulation protocols (TABLE 1): long GnRH-agonist (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Fábregues et al, 2013;Requena et al, 2014;Bleau et al, 2017;Renzini et al, 2017;Tehraninejad et al, 2017;Xia et al, 2019), GnRH-antagonist (Schwarze et al, 2016), both (Revelli et al, 2015), or long GnRH-agonist and microdose flair GnRH-agonist (Dahan et al, 2014). Considering the type and source of gonadotrophin preparations, eight used HMG (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Dahan et al, 2014;Revelli et al, 2015., Schwarze et al, 2016Bleau et al, 2017;Tehraninejad et al, 2017;Xia et al, 2019) and three used HP-HMG (Fábregues et al, 2013;Requena et al, 2014;Renzini et al, 2017).…”

“…The studies used different ovarian stimulation protocols (TABLE 1): long GnRH-agonist (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Fábregues et al, 2013;Requena et al, 2014;Bleau et al, 2017;Renzini et al, 2017;Tehraninejad et al, 2017;Xia et al, 2019), GnRH-antagonist (Schwarze et al, 2016), both (Revelli et al, 2015), or long GnRH-agonist and microdose flair GnRH-agonist (Dahan et al, 2014). Considering the type and source of gonadotrophin preparations, eight used HMG (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Dahan et al, 2014;Revelli et al, 2015., Schwarze et al, 2016Bleau et al, 2017;Tehraninejad et al, 2017;Xia et al, 2019) and three used HP-HMG (Fábregues et al, 2013;Requena et al, 2014;Renzini et al, 2017). Moreover, nine used LH preparation during the stimulation period (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Fábregues et al, 2013;Dahan et al, 2014;Requena et al, 2014;Revelli et al, 2015;Schwarze et al, 2016;Renzini et al, 2017;Xia et al, 2019), whereas two studies (Bleau et al, 2017;Tehraninejad et al, 2017) added the LH preparation only after 5 and 6 days of FSH treatment, respectively.…”

“…Considering the type and source of gonadotrophin preparations, eight used HMG (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Dahan et al, 2014;Revelli et al, 2015., Schwarze et al, 2016Bleau et al, 2017;Tehraninejad et al, 2017;Xia et al, 2019) and three used HP-HMG (Fábregues et al, 2013;Requena et al, 2014;Renzini et al, 2017). Moreover, nine used LH preparation during the stimulation period (Pacchiarotti et al, 2010;Buhler and Fischer, 2012;Fábregues et al, 2013;Dahan et al, 2014;Requena et al, 2014;Revelli et al, 2015;Schwarze et al, 2016;Renzini et al, 2017;Xia et al, 2019), whereas two studies (Bleau et al, 2017;Tehraninejad et al, 2017) added the LH preparation only after 5 and 6 days of FSH treatment, respectively. The daily dose of the LH-activity in the HMG preparations was reported in eight studies and ranged between 75 and 300 IU, whereas, in recombinant LH, it was 75-300 IU (TABLE 1).…”