Among patients treated with FSH and GnRH analogues for in vitro fertilization, is the addition of recombinant LH associated with the probability of live birth? A systematic review and meta-analysis

Abstract

The aim of this systematic review and meta-analysis was to assess whether the addition of recombinant luteinizing hormone (LH) increases live birth rate, among patients treated with follicle stimulating hormone (FSH) and gonadotrophin-releasing hormone (GnRH) analogues for in vitro fertilization (IVF). Eligible studies were randomized controlled trials (RCTs) answering the research question that contained sufficient information to allow ascertainment of whether randomization was true and whether equality was present between the groups compared, regarding baseline demographic characteristics, gonadotrophin stimulation protocol, number of embryos transferred and luteal phase support administered. A literature search identified seven RCTs (701 patients) that provided the information of interest, among which five reported agonist and two antagonist cycles. The reported outcome measure, clinical pregnancy, was converted to live birth using published data in one study. No significant difference in the probability of live birth was present with or without rLH addition to FSH (odds ratio [OR]: 0.92, 95% confidence interval (CI): 0.65-1.31; P 5 0.65). This finding remained stable in subgroup analyses that ordered the studies by dose of rLH added, the type of analogue used to inhibit premature LH surge, the time rLH was added during the follicular phase, the age of patients analysed, the presence of allocation concealment and by the way the information on live birth was retrieved. In conclusion, the available evidence does not support the hypothesis that the addition of recombinant LH increases the live birth rate in patients treated with FSH and GnRH analogues for IVF.

Efficacy of low dose hCG on oocyte maturity for ovarian stimulation in poor responder women undergoing intracytoplasmic sperm injection cycle: a randomized controlled trial

“…A similar result was reported in a meta analysis on seven randomized clinical trials which rLH added to rFSH in GnRH agonist protocols [46]. Although all patients in this study were selected from a poor respond population, no cycle cancellation was noted in three groups during the treatment cycle.…”

Improved pregnancy rates with luteinizing hormone supplementation in patients undergoing ovarian stimulation for IVF

“…A previous meta-analysis of randomised controlled trials showed that pregnancy and live birth rates were not different between cycles using rLH supplementation versus rFSH alone [11]. However, it was cautioned in this review that the sample size available through the 7 RCTs was not adequate to determine clinical significance.…”

“…Prior meta-analyses have not suggested any improvement in pregnancy outcomes with LH supplementation [11,16]. However, a recent study of normogonadotrophic women showed an increase in the number of oocytes collected, number of oocytes in metaphase II, fertilization rate, implantation rate and live birth rate in those that had LH supplementation [9].…”

Elevated day 3 FSH/LH ratio: a marker to predict IVF outcome in young and older women

“…It was suggested that the exogenous addition of LH may be of benefit in this subgroup of women in order to improve IVF outcomes [10]. The use of LH for IVF stimulation is a debated issue in the literature and it has not been shown a [19,20]. Moreover, the role of the supplementation of LH in the women with high basal FSH/LH ratio and lower LH concentration has not been investigated.…”