Recombinant human luteinizing hormone, lutropin alfa, for the induction of follicular development and pregnancy in profoundly gonadotrophin‐deficient women

Kaufmann, Robert A.; Dunn, Randall C.; Vaughn, T.C.; Hughes, Graeme J.; O’Brien, Fanny; Hemsey, George; Thomson, Barbara A.; O’Dea, Louis

doi:10.1111/j.1365-2265.2007.02925.x

Cited by 39 publications

(30 citation statements)

References 28 publications

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“…Our data support the theory that there is an LH threshold below which adverse effects are seen in human assisted reproduction. Studies on patients with hypothalamic amenorrhea have shown the addition of LH is necessary to achieve appropriate follicular and endometrial development (20)(21)(22)(23)(24)(25). However, it has also been shown that many normogonadotropic patients can be stimulated successfully with FSH alone in both GnRH antagonist and GnRH agonist cycles (26)(27)(28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

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

Hill

Bates

et al. 2011

Fertility and Sterility

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Section: Discussionmentioning

confidence: 99%

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

Hill

Bates

et al. 2011

Fertility and Sterility

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“…225 One caveat is that most women with CHH do not secrete endogenous LH and, thus, require a complement of LH to stimulate local production of androgen substrates by theca cells, which facilitates sufficient secretion of estradiol by the dominant follicle. [226][227][228] Physiologic estradiol secretion promotes optimal endometrial development and the cervical mucus production needed for sperm transit and embryo implantation. 229 Typically, subcutaneous FSH doses of 75-150 IU per day are sufficient.…”

Section: Induction Of Female Sexual Characteristicsmentioning

confidence: 99%

European Consensus Statement on congenital hypogonadotropic hypogonadism—pathogenesis, diagnosis and treatment

et al. 2015

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| Congenital hypogonadotropic hypogonadism (CHH) is a rare disorder caused by the deficient production, secretion or action of gonadotropin-releasing hormone (GnRH), which is the master hormone regulating the reproductive axis. CHH is clinically and genetically heterogeneous, with >25 different causal genes identified to date. Clinically, the disorder is characterized by an absence of puberty and infertility. The association of CHH with a defective sense of smell (anosmia or hyposmia), which is found in ~50% of patients with CHH is termed Kallmann syndrome and results from incomplete embryonic migration of GnRHsynthesizing neurons. CHH can be challenging to diagnose, particularly when attempting to differentiate it from constitutional delay of puberty. A timely diagnosis and treatment to induce puberty can be beneficial for sexual, bone and metabolic health, and might help minimize some of the psychological effects of CHH. In most cases, fertility can be induced using specialized treatment regimens and several predictors of outcome have been identified. Patients typically require lifelong treatment, yet ~10-20% of patients exhibit a spontaneous recovery of reproductive function. This Consensus Statement summarizes approaches for the diagnosis and treatment of CHH and discusses important unanswered questions in the field.

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“…Stimulation studies with highly purified or recombinant FSH showed a clear correlation between remaining LH levels and stimulation outcome in HH women 1,53,70,103. Below a LH level of 1 U/L, FSH alone was not capable of stimulating follicular growth 104.…”

Section: Gonadotropic Treatment In Hh Womenmentioning

confidence: 97%

“…The low or undetectable gonadotropins portray the common endpoint of different diseases and circumstances. Despite a few cases of pituitary origin such as adenomas or inflammation (hypophysitis), the majority of HH patients suffer from a disturbed hypothalamic gonadotropin-releasing hormone (GnRH) secretion 1,2. The irregular GnRH secretion can be traced back to a morphological correlate such as Kallmann’s syndrome, adrenal hypoplasia congenita (in men), GnRH gene mutation or Leptin gene mutation in just 10% of all cases 3,4.…”

Section: Introductionmentioning

confidence: 99%

Lutropin alpha, recombinant human luteinizing hormone, for the stimulation of follicular development in profoundly LH-deficient hypogonadotropic hypogonadal women: a review

Krause¹

2009

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Hypogonadotropic hypogonadism is defined as a medical condition with low or undetectable gonadotropin secretion, associated with a complete arrest of follicular growth and very low estradiol. The main cause can be traced back to an irregular or absent hypothalamic GnRH secretion, whereas only a minority suffers from a pituitary disorder. The choice of treatment to reverse this situation is a pulsatile GnRH application or a direct ovarian stimulation using gonadotropin injections. The goal is to achieve a proper ovarian function in these cases for a short time to allow ovulation and chance of pregnancy. Since the pulsatile GnRH treatment lost its former importance, several gonadotropins are in use to stimulate follicular growth, such as urine-derived human menopausal gonadotropin, highly purified follicle stimulating hormone (FSH) or recombinant FSH, all with different success. The introduction of recombinant luteinizing hormone (LH) and FSH provided an opportunity to investigate the distinct influences of LH and FSH alone and in combination on follicular growth in monofollicular ovulation induction cycles, and additionally on oocyte maturation, fertilization competence of the oocyte and embryo quality in downregulated IVF patients. Whereas FSH was known to be indispensable for normal follicular growth, the role of LH remained questionable. Downregulated IVF patients with this short-term gonadotropin depletion displayed no advance in stimulation success with the use of recombinant LH. Patients with hypogonadotropic hypogonadism undergoing monofollicular stimulation for ovulation induction showed clearly a specific role and need for both hormones in normal follicular growth. Therefore, a combined stimulation with FSH and LH seems to be the best treatment choice. In the first half of the stimulation cycle the FSH dosage should exceed that of LH by 2:1, with an inverse ratio for the second half.

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Recombinant human luteinizing hormone, lutropin alfa, for the induction of follicular development and pregnancy in profoundly gonadotrophin‐deficient women

Abstract: Coadministration of lutropin alfa 75 IU and follitropin alfa is safe and effective in inducing follicular development and pregnancy in hypogonadotrophic hypogonadal women with profound gonadotrophin deficiency in a setting consistent with established medical practice.

Cited by 39 publications

References 28 publications

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

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

European Consensus Statement on congenital hypogonadotropic hypogonadism—pathogenesis, diagnosis and treatment

Lutropin alpha, recombinant human luteinizing hormone, for the stimulation of follicular development in profoundly LH-deficient hypogonadotropic hypogonadal women: a review

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