1. Overview
Role of LH during the natural
menstrual cycle
Methods to identify patients who may
benefit from LH supplementation?
 Before COS
 During COS
 Type
 Dose
 Timing

3. Methods to identify patients who may
benefit from LH supplementation?
Before COS
During COHHypogonadotropic hypogonadism
(The European Recombinant Human LH Study Group, 1998)
Follicular development can be achieved
with both LH+FSH and FSH alone,
BUT with FSH alone:
• inadequate E2
• reduced occurrence of ovulation
• decreased endometrial thickness
• lower oocyte fertilization rates
LH

4. Methods to identify patients who may
benefit from LH supplementation?
Before COS
Poor responders & patients >35yrs
Mochtar et al 2007

5. Methods to identify patients who may
benefit from LH supplementation?
Before COS
Patients with high basal FSH/LH ratio
day 3 LH value <3 IU/L
day 3 FSH/LH ratio >3.6
predictive of a poor response to the long
GnRH-agonist suppressive COS protocol.
(Mukherjee 1996)
1996

6. Methods to identify patients who may
benefit from LH supplementation?
Before COS
During COS
antagonist administration
gonadotropin administration
pre-treatment cycle treatment cycle
agonist administration
gonadotropin administration

7. Alviggi et al. 2006
‘Steady response’ (10-12%)
(De Placido et al, 2005)

8. During COS with GnRH-antagonist
Methods to identify patients who may
benefit from LH supplementation?
During COS
Is there any association between endogenous
LH and pregnancy in patients undergoing
COS with GnRH antagonist?

9. Progesterone elevation was associated with increased
number of COCs and E2 levels.
Intense stimulation

10. Methods to identify patients who may
benefit from LH supplementation
Before COS
During COS
- Hypogonadotropic hypogonadism
- Poor responders & patients >35yrs
- Patients with high basal FSH/LH ratio
GnRH-Agonist
- Steady response
- Patients with Day 8 LH>1.99.
-Relative reduction in mid/late follicular LH
concentrations.
GnRH-Antagonist
- P>1-1.2 on day of hCG administration