• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
LH hormone in assited reproduction
 

LH hormone in assited reproduction

on

  • 1,197 views

In recent years ,our understanding of Lh is increasing day by day.In this presentation effort made to provide current understanding of Lh inassisted reproduction.

In recent years ,our understanding of Lh is increasing day by day.In this presentation effort made to provide current understanding of Lh inassisted reproduction.

Statistics

Views

Total Views
1,197
Views on SlideShare
1,197
Embed Views
0

Actions

Likes
2
Downloads
57
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment
  • The most common protocol in assisted reproduction is daily injection of gonadotrophin .these are generally combined with gonadotrophin agonist or antagonist to avoid premature lh surge Shoohan in 2002 demonsrttrated follicles increasingly become sensitive and ultimatleydpendent on lhSome scientistb advocated adding lh as adback and other felt unnessaryA cochrane review was published in 2009 Mochart
  • The most common protocol in assisted reproduction is daily injection of gonadotrophin .these are generally combined with gonadotrophin agonist or antagonist to avoid premature lh surge Shoohan in 2002 demonsrttrated follicles increasingly become sensitive and ultimatleydpendent on lhSome scientistb advocated adding lh as adback and other felt unnessaryA cochrane review was published in 2009 Mochart
  • Bad controlled imposrtant harmful and helpful in some Primary aim of thw talk to give clarity with scientific work Invidualised the protocol
  • PhysiologySecretion of gonadotrophin FSH LH play a distint complementary role to ensure growth and ovulation The only cell containgfsh receptors is the granulosa cellLh receptors are found in granulosa theca cell and uterus Androgen diffuse into the granulosa cell where aromatase enzyme agumented by fshconvertes to estrogenThis action occurs at 10-12 mmFollicular steroidogenesisStimulation of androgen synthesis by theca cellsFollicular maturationCan support terminal stages of follicular maturationOvulationResumption of meiosisOvulationLuteinizationMaintenance of luteal function
  • Follicular development can iniated by any of the following 1 GNRH2 U HMGHuman fsh and fshThe concept is giving back what is needed
  • Not every woman needs lh supplementation and as most of the women will respond with extremly low levels of lh .Infact only 1 % receptor occupation will be suffice Day 6 lh level 0.5 miu/mlThese pt had more oocyte ,6.3 to 7.3 ,higher fertilization rate 92% versus 69%pregnancy rate and implanatation rate and on going pregnancy rate 22% and 5 %
  • Only when lh is given in a dose of 1325 units then it crosses celing window
  • Not every woman needs lh supplementation and as most of the women will respond with extremly low levels of lh .Infact only 1 % receptor occupation will be suffice Day 6 lh level 0.5 miu/mlThese pt had more oocyte ,6.3 to 7.3 ,higher fertilization rate 92% versus 69%pregnancy rate and implanatation rate and on going pregnancy rate 22% and 5 %
  • Not every woman needs lh supplementation and as most of the women will respond with extremly low levels of lh .Infact only 1 % receptor occupation will be suffice Day 6 lh level 0.5 miu/mlThese pt had more oocyte ,6.3 to 7.3 ,higher fertilization rate 92% versus 69%pregnancy rate and implanatation rate and on going pregnancy rate 22% and 5 %

LH hormone in assited reproduction LH hormone in assited reproduction Presentation Transcript

  • Lh in assisted Reproduction
    Dr G A RAMA RAJU.
    KRISHNAIVF
    VISAKHAPATNAM.
  • Dr.Subhasmukherjee
    http://drsubhasmukhopadhyay.blogspot.com/
    I dedicate this lecture
  • LH
  • Is there a need for recombinant luteinizing hormone?
    Has the appropriate patient population been defined?
    Has a safe and effective dose been identified?
    75 IU/day
    Is the composite primary endpoint of follicular development an appropriate endpoint to assess efficacy in this patient population?
    4
  • Luveris® (lutropin alfa for injection)
  • Agenda
  • LH and FSH Action on the Follicle
    E2
    A
    Theca externa cells
    FSH receptors on granulosa cells
    Theca interna cells
    LH receptorson theca cells
    Granulosa
    cells
    FSH
    Follicular
    antrum
    Zona pellucida
    Oocyte
    Cumulus
    Oophorus
    cells
    LH
    Capillary network
    Basement membrane
    7
  • The LH Therapeutic Window Concept
    • Suppression of granulosa cell proliferation
    • Follicular atresia (nondominant follicles)
    • Premature luteinization (preovulatory follicle)
    • Oocyte development compromised
    LH ceiling
    Normal follicular growth and development
    Normal androgen and estrogen biosynthesis
    Normal oocyte maturation
    LH threshold
    • Follicular growth impaired
    • Inadequate androgen (and estrogen) synthesis
    • No full oocyte maturation
    Balasch J, Fábreques F. Curr Opin Obstet Gynecol 2002, 14:265-274
    8
  • CNS Influence
    GnRH
    LH FSH
    Steroidal and
    Nonsteroidal
    Feedback
    9
    HH Can Be Caused by Hypothalamic Disorders, Pituitary Disease or Both
    Hypothalamus
    Pituitary
    Ovary
  • HH Treated with r-hFSH Alone
    9
    0
    r-hFSH
    15
    Follicle
    Follicle Size
    (mm)
    and FSH(IU/L)
    Estradiol
    (pg/ml)
    10
    Serum FSH
    5
    Estradiol
    100
    50
    0
    0
    5
    10
    15
    20
    Days
    Endometrial
    Thickness
    (mm)
    Shoham Z et al. Fertil Steril 1993; 59:738
    10
  • HH Treated with r-hFSH and r-hLH
    Follicle
    20
    400
    350
    15
    300
    Follicle Size
    (mm)
    and FSH(IU/L)
    250
    10
    200
    Serum FSH
    150
    5
    100
    Estradiol
    50
    0
    0
    0
    5
    10
    15
    20
    Days
    Endometrial
    Thickness
    (mm)
    9
    0
    r-hFSH
    r-hLH
    Estradiol
    (pg/ml)
    Serono data Study 6253
    11
  • 12
    Follicular Development in HH
    Give back what’s missing
  • Beneficial effect of LH supplementation in ART
    > 5
    < .5
  • LH
    14
  • Beneficial effect of LH supplementation in ART
  • Women > 35 years:
    16
  • Poor responders:
    10-15% of IVF patients have an inadequate response to FSH stimulation by day 8
    De Placido et al, 2001, 2004
     
    Women showing a hypo-responsive response in IVF down regulated cycles had asignificant increase in pregnancy and implantation rates with the addition ofrecombinant LH (40.7% vs. 22%)
    Ferraretti et al, 2004
    Prospective randomised controlled trial
     
    rLH supplementation is more effective than increasing the dose of rFSH inpatients with an initial inadequate ovarian response to r FSH alone
    De Placido et al, 2005
    Multicenter, prospective, randomised controlled trial
  • Beneficial effect of LH supplementation in ART
  • How did an optimal dose found. Dose Finding Studies LH
    Controlled ovarian stimulation and HH
    19
  • Percentage of Patients with Follicular Development
    Trend Test*
    p = 0.004
    1/9
    2/8
    7/11
    7/10
    p = 0.467
    p = 0.020
    p = 0.012
    p-values vs 0 IU LH
    * Statistically significant and robust
    20
  • 21
    Risks
    Known complications of gonadotropins in infertility treatment
    Ovarian Hyperstimulation Syndrome (OHSS)
    Multiple births
    Other minimal/transient treatment-related adverse events (minor)
    Risks mitigated with proper diagnosis, dosing and observation
  • 22
    Risks vs. Benefits
  • ASIA PACIFIC LH ADBOARD.
  • ASIA PACIFIC LH ADBOARD.
  • Indian study :krishnaivf LH study submitted for publication
  • Adding Lh
    26
  • Thank u
    27