Recombinant LH supplementation to a standard GnRH antagonist protocol in women of 35 years or older undergoing IVF/ICSI: a randomized controlled multicentre study

König, T.E.; Houwen, Lisette E.E. van der; Overbeek, A.; Hendriks, Matthijs L.; Beutler-Beemsterboer, S.N.; Kuchenbecker, Walter K. H.; Renckens, C N M; Bernardus, Rob E.; Schats, R.; Homburg, Roy; Hompes, Peter G.A.; Lambalk, Cornelis B.

doi:10.1093/humrep/det266

Cited by 71 publications

(69 citation statements)

References 22 publications

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“…the number of retrieved oocytes in total age group, 9.6 ± 6.7 vs 8.5 ± 5.5, N.S. ), and it is consistent with those two studies [14, 15]. …”

Section: Discussionsupporting

confidence: 92%

“…Chung et al [14] performed a retrospective study in 141 cases stratified by an age of <40 years and >40 years. In addition, König et al [15] conducted a randomized controlled trial in 253 patients only aged >35 years on LH supplementation. Our study was retrospective but included larger numbers of patients (465 patients) with mean age 38.8 years (29–45 years), which consisted of 72 patients (15 %) in <35 years old and 393 patients (85 %) in ≥35 years old.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of FSH and hMG on ovarian stimulation outcome with a GnRH antagonist protocol in younger and advanced reproductive age women

Tabata

Fujiwara

Sugawa

et al. 2014

Reprod Medicine & Biology

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PurposeTo compare the embryo outcomes of in vitro fertilization/intra-cytoplasmic sperm injection with a gonadotropin-releasing hormone (GnRH) antagonist protocol with follicle stimulating hormone (FSH) and with human menopausal gonadotropin (hMG).MethodsWe performed a retrospective cohort study in 465 patients. Stimulation was started by daily FSH injection, and either FSH was continued (FSH alone group) or hMG was administrated (FSH-hMG group) after administration of a GnRH antagonist. Primary outcomes were the embryo profile (number of retrieved, mature, and fertilized eggs, and morphologically good embryos on day 3) and endocrine profile. Secondary outcomes were the doses and durations of gonadotropin. Data were stratified by the patients’ age into two groups: <35 years and ≥35 years.ResultsIn patients aged <35 years, the number of retrieved oocytes in the FSH alone group was significantly increased than that in the FSH-hMG group (13.7 vs 9.2, P = 0.04), while there was no difference at other age groups. The FSH-hMG group required a significantly greater amount of gonadotropins at any age (all ages, P < 0.001; <35 years, P = 0.013; ≥35 years, P < 0.001).ConclusionsExogenous FSH alone is probably sufficient for follicular development and hMG may not improve the embryo profile in a GnRH antagonist protocol across all age.

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“…the number of retrieved oocytes in total age group, 9.6 ± 6.7 vs 8.5 ± 5.5, N.S. ), and it is consistent with those two studies [14, 15]. …”

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Comparison of FSH and hMG on ovarian stimulation outcome with a GnRH antagonist protocol in younger and advanced reproductive age women

Tabata

Fujiwara

Sugawa

et al. 2014

Reprod Medicine & Biology

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“…This might be expected as there is a general trend for delayed childbearing in Western societies [19], with many couples seeking ART for this reason [20]. However, although a recent study has failed to find differences in outcomes for women ≥35 years treated with or without LH supplementation during COS [21], there are a growing number of studies that have demonstrated a benefit from LH supplementation [5], which may have contributed to older patients being prescribed the 2:1 formulation of follitropin alfa and lutropin alfa and consequently entering this study. For example, in a recent meta-analysis of data from patients aged ≥35 years (7 randomized controlled trials; 902 ART cycles) r-hLH supplementation of r-hFSH for COS resulted in higher implantation (odds ratio [OR]: 1.36; 95% confidence interval [CI]: 1.05, 1.78) and clinical pregnancy (OR: 1.37; 95% CI: 1.03, 1.83) rates than r-hFSH alone [22].…”

Section: Discussionmentioning

confidence: 99%

A large, multicentre, observational, post-marketing surveillance study of the 2:1 formulation of follitropin alfa and lutropin alfa in routine clinical practice for assisted reproductive technology

Bühler¹,

Naether²,

Bilger

2014

Reprod Biol Endocrinol

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BackgroundFollicle-stimulating hormone (FSH) and luteinizing hormone (LH) both have a role to play in follicular development during the natural menstrual cycle. LH supplementation during controlled ovarian stimulation (COS) for assisted reproductive technology (ART) is used for patients with hypogonadotropic hypogonadism. However, the use of exogenous LH in COS in normogonadotropic women undergoing ART is the subject of debate. The aim of this study was to investigate characteristics of infertile women who received the 2:1 formulation of follitropin alfa and lutropin alfa (indicated for stimulation of follicular development in women with severe LH and FSH deficiency) in German clinical practice.MethodsA 3-year, multicentre, open-label, observational/non-interventional, post-marketing surveillance study of women (21-45 years) undergoing ART. Primary endpoint: reason for prescribing the 2:1 formulation of follitropin alfa and lutropin alfa. Secondary variables included: COS duration/dose; oocytes retrieved; fertilization; clinical pregnancy; ovarian hyperstimulation syndrome (OHSS).ResultsIn total, 2220 cycles were assessed; at least one reason for prescribing the 2:1 formulation was given in 1834/2220 (82.6%) cycles. Most common reasons were: poor ovarian response (POR) (39.4%), low baseline LH (17.8%), and age (13.8%). COS: mean dose of the 2:1 formulation on first day, 183.1/91.5 IU; mean duration, 10.8 days. In 2173/2220 (97.9%) cycles, human chorionic gonadotrophin was administered. Oocyte pick-up (OPU) was attempted in 2108/2220 (95.0%) cycles; mean (standard deviation) 8.0 (5.4) oocytes retrieved/OPU cycle. Fertilization (≥1 oocyte fertilized) rates: in vitro fertilization (IVF), 391/439 (89.1%) cycles; intracytoplasmic sperm injection (ICSI)/IVF + ICSI, 1524/1613 (94.5%) cycles. Clinical pregnancy rate: all cycles, 25.9%; embryo transfer cycles, 31.3%. OHSS: hospitalization for OHSS, 8 (0.36%) cycles, Grade 2, 60 (2.7%), and Grade 3, 1 (0.05%).ConclusionsIn German routine clinical practice, the most common reasons for using the 2:1 formulation of follitropin alfa and lutropin alfa for women undergoing ART were POR, low baseline LH, and age. Severe OHSS incidence was low and similar to that reported previously.Trial registrationClinicaltrials.gov NCT01112618

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“…There were no demographic or clinical differences between the groups. They concluded that LH supplementation has no benefit on ongoing pregnancy rates in women of 35 years or older (König et al, 2013). Vuong et al (2015), through a randomized controlled trial evaluated a total of 240 women aged ≥ 35 years undergoing IVF received ovarian stimulation through a GnRH antagonist protocol.…”

Section: Recombinant Lh Administration In Older Assisted Reproductionmentioning

confidence: 99%

Use of recombinant luteinizing hormone for controlled ovarian hyperstimulation in infertile patients

Maia

Approbato

Silva

et al. 2016

JBRA Assisted Reproduction

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Controlled ovarian stimulation has become an integral part of a high complexity infertility treatment. Treatment options with recombinant gonadotrophins add more to knowledge on folliculogenesis and ovarian steroidogenesis. Therefore, a literature search was conducted in the following data bases: Medline, Scielo and PubMed. The descriptors/key words used were ovarian stimulation, in vitro fertilization, recombinant luteinizing hormone, supplementation LH. The aim of this study was to review the available literature and to assess the benefits of using recombinant luteinizing hormone associated with recombinant follicle stimulating hormone in different populations who have undergone assisted reproduction procedures.

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Recombinant LH supplementation to a standard GnRH antagonist protocol in women of 35 years or older undergoing IVF/ICSI: a randomized controlled multicentre study

Abstract: The trial was registered in the Dutch trial register (ISRCTN10841210).

Cited by 71 publications

References 22 publications

Comparison of FSH and hMG on ovarian stimulation outcome with a GnRH antagonist protocol in younger and advanced reproductive age women

Comparison of FSH and hMG on ovarian stimulation outcome with a GnRH antagonist protocol in younger and advanced reproductive age women

A large, multicentre, observational, post-marketing surveillance study of the 2:1 formulation of follitropin alfa and lutropin alfa in routine clinical practice for assisted reproductive technology

Use of recombinant luteinizing hormone for controlled ovarian hyperstimulation in infertile patients

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