Evaluating the role of exogenous luteinizing hormone in poor responders undergoing in vitro fertilization with gonadotropin-releasing hormone antagonists

Objective

To evaluate the importance of exogenous LH in poor responders undergoing IVF with GnRH antagonists.

Design

Retrospective cohort study.

Setting

University-based IVF center.

Patient(s)

All patients with a history of poor response to ovarian stimulation undergoing IVF with GnRH antagonists between September 2000 and August 2001.

Intervention(s)

None.

Main Outcome Measure(s)

Clinical pregnancy rates.

Result(s)

Two hundred forty GnRH-antagonist cycles were initiated in poor responders. One hundred fifty-three progressed to oocyte retrieval. Seventy-five patients received recombinant FSH (Rec) for ovarian stimulation, and 66 received hMG in combination with Rec. In patients aged <40 years, there were no significant differences in amount and duration of treatment, number of oocytes retrieved, and number of embryos between treatment groups. In patients aged ≥40 years, significantly fewer oocytes were retrieved in groups who received exogenous LH in their stimulation, resulting in significantly fewer fertilized embryos. Implantation and clinical pregnancy rates did not differ by treatment group.

Conclusion(s)

In poor responders undergoing IVF with GnRH antagonists, outcomes are comparable whether stimulation is achieved in the presence or absence of supplemental LH. Exogenous LH does not appear to be necessary to achieve pregnancy in these challenging patients and may be detrimental to older patients with a history of poor response.

Key Words:  Gonadotropin-releasing hormone antagonist , luteinizing hormone , poor responders , IVF