Low-dose human chorionic gonadotropin may improve in vitro fertilization cycle outcomes in patients with low luteinizing hormone levels after gonadotropin-releasing hormone antagonist administration

Propst, Anthony M.; Hill, Micah J.; Bates, G. Wright; Palumbo, Michelle; Horne, A.K. Van; Retzloff, Matthew G.

doi:10.1016/j.fertnstert.2011.06.069

Cited by 25 publications

(24 citation statements)

References 70 publications

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“…The endogenous LH concentrations appear not to be associated with pregnancy rates in normogonadotropic patients undergoing stimulation with rFSH in GnRH antagonist cycles [16]. Nevertheless, a retrospective study in patients stimulated with rFSH supplemented with urinary hCG, 50 IU or 100 IU daily, in a GnRH antagonist protocol reported that the patients with LH concentrations below 0.5 IU/L after start of the GnRH antagonist had significantly higher live-birth rates than the patients treated with rFSH alone [17]. …”

Section: Discussionmentioning

confidence: 99%

Live-birth rates after HP-hMG stimulation in the long GnRH agonist protocol: association with mid-follicular hCG and progesterone concentrations, but not with LH concentrations

Arce

Smitz

2012

Gynecological Endocrinology

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The aim of this retrospective study was to investigate the impact of endogenous and exogenous luteinizing hormone (LH) activity on treatment outcome, when taking into consideration potential confounding variables. Data were derived from IVF patients (n = 358) stimulated with highly purified menotrophin (HP-hMG) in a long gonadotrophin-releasing hormone (GnRH) agonist protocol. Simple retrospective logistic regression analysis showed that the mid-follicular exogenous concentrations of human chorionic gonadotrophin (hCG) (p = 0.027), provided by the HP-hMG preparation, and female age (p = 0.009) were significantly associated with live-birth rate, while the mid-follicular progesterone concentration (p = 0.075), the estradiol concentration on last stimulation day (p = 0.075) and number of embryos transferred (p = 0.071) were borderline significant. Endogenous LH was not associated with live-birth rate; neither at start of stimulation (p = 0.123), nor in the mid-follicular phase (p = 0.933) or on the last day of stimulation (p = 0.589). In the multiple regression analysis of life birth, mid-follicular hCG (p = 0.016) was identified as a positive predictor, and age (p = 0.004) and mid-follicular progesterone (p = 0.029) as negative predictors. In conclusion, mid-follicular concentrations of exogenous hCG and progesterone, but not endogenous LH, are associated with live-birth rate in IVF patients treated with HP-hMG in a long GnRH agonist cycle.

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Section: Discussionmentioning

confidence: 99%

Live-birth rates after HP-hMG stimulation in the long GnRH agonist protocol: association with mid-follicular hCG and progesterone concentrations, but not with LH concentrations

Arce

Smitz

2012

Gynecological Endocrinology

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“…With this in mind, human menopausal gonadotropin (hMG) is commonly used as preparation with LH-like activity, due to the presence of LH and/or hCG molecules. hMG alone and hCG/LH + FSH were repeatedly proposed (10, 11) but some unfavorable results, in particular in terms of number of oocytes retrieved (12, 13), provided concerns about the usefulness of addition of “LH activity.”…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Follicle-Stimulating Hormone (FSH) Alone, FSH + Luteinizing Hormone, Human Menopausal Gonadotropin or FSH + Human Chorionic Gonadotropin on Assisted Reproductive Technology Outcomes in the “Personalized” Medicine Era: A Meta-analysis

et al. 2017

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SettingLuteinizing hormone (LH) and human chorionic gonadotropin (hCG) act on the same receptor, activating different signal transduction pathways. The role of LH or hCG addition to follicle-stimulating hormone (FSH) as well as menopausal gonadotropins (human menopausal gonadotropin; hMG) in controlled ovarian stimulation (COS) is debated.ObjectiveTo compare FSH + LH, or FSH + hCG or hMG vs. FSH alone on COS outcomes.DesignA meta-analysis according to PRISMA statement and Cochrane Collaboration was performed, including prospective, controlled clinical trials published until July 2016, enrolling women treated with FSH alone or combined with other gonadotropins. Trials enrolling women with polycystic ovarian syndrome were excluded (PROSPERO registration no. CRD42016048404).ResultsConsidering 70 studies, the administration of FSH alone resulted in higher number of oocytes retrieved than FSH + LH or hMG. The MII oocytes number did not change when FSH alone was compared to FSH + LH, FSH + hCG, or hMG. Embryo number and implantation rate were higher when hMG was used instead of FSH alone. Pregnancy rate was significantly higher in FSH + LH-treated group vs. others. Only 12 studies reported live birth rate, not providing protocol-dependent differences. Patients’ stratification by GnRH agonist/antagonist identified patient subgroups benefiting from specific drug combinations.ConclusionIn COS, FSH alone results in higher oocyte number. HMG improves the collection of mature oocytes, embryos, and increases implantation rate. On the other hand, LH addition leads to higher pregnancy rate. This study supports the concept of a different clinical action of gonadotropins in COS, reflecting previous in vitro data.

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“…In a subsequent publication, this same group demonstrated that low dose hCG was effective at significantly improving implantation rates (54% vs. 19%) and live-birth rates (64% vs. 25%) in patients who had endogenous LH levels ≤ 0.5 IU/L, while it had no benefit in patients with LH levels >0.5 IU/L (58). A metaanalysis of over 1,000 patients has demonstrated that the addition of hCG to ovarian stimulation results in a decreased requirement for rFSH, leading to a cost savings with comparable outcomes (108).…”

Section: Human Chorionic Gonadotropinmentioning

confidence: 97%

“…Below LH levels of 1IU/L, other researchers demonstrated slower follicular growth and decreased estradiol (56). Finally, LH levels < 0.5 IU/L have been associated with increased pregnancy loss, lower implantation rates, and lower live birth rates (57,58). It has also been demonstrated that elevated LH levels are associated with negative ART cycle outcomes.…”

Section: Potential Mechanisms Of Exogenous Lh Benefit In Artmentioning

confidence: 98%

The Use of rLH, HMG and hCG in Controlled Ovarian Stimulation for Assisted Reproductive Technologies

Hill¹,

Propst²

2012

Enhancing Success of Assisted Reproduction

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Low-dose human chorionic gonadotropin may improve in vitro fertilization cycle outcomes in patients with low luteinizing hormone levels after gonadotropin-releasing hormone antagonist administration

Cited by 25 publications

References 70 publications

Live-birth rates after HP-hMG stimulation in the long GnRH agonist protocol: association with mid-follicular hCG and progesterone concentrations, but not with LH concentrations

Live-birth rates after HP-hMG stimulation in the long GnRH agonist protocol: association with mid-follicular hCG and progesterone concentrations, but not with LH concentrations

Efficacy of Follicle-Stimulating Hormone (FSH) Alone, FSH + Luteinizing Hormone, Human Menopausal Gonadotropin or FSH + Human Chorionic Gonadotropin on Assisted Reproductive Technology Outcomes in the “Personalized” Medicine Era: A Meta-analysis

The Use of rLH, HMG and hCG in Controlled Ovarian Stimulation for Assisted Reproductive Technologies

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