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Lh hormone 2017
This document discusses the rationale for using luteinizing hormone (LH) for ovulation induction and superovulation. It notes that LH plays an important role in the mid-follicular phase by regulating theca cell function and androgen production, which is necessary for follicular development. The concept of an optimal "therapeutic window" of LH levels is introduced, with both insufficient and excessive LH being detrimental to follicular growth and oocyte maturation. Certain patient groups, such as poor responders, older women, and those with LH polymorphisms, may benefit from LH supplementation during assisted reproductive technology cycles to improve outcomes.
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Lh hormone 2017
- 1. RATIONALE FOR USEOF LH FOR OVULATION INDUCTION AND SUPER OVULATION
- 2. Carrying feelings oflove and affection Krishna IVF Clinic
- 3. Ryan and colleagues 1960 Twocell two gonadotrophin Fsh granulosa cell Lh on theca cell
- 4. Role of lh •mid follicular phase
- 5. LH the master regulator Erk1and Erk2 mediate the luteinizing hormone
- 6. Mile stones indevelopment of gonadotropin 18 yrs.
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- 8. SO MANY BENEFITS?THEN WHY 1 BASIC PHYSIOLOGY 2 DIFFERENT PROTOCOLS 3 DIFFERENT DRUGS 4 therapeutic window
- 9. SO MANY BENEFITS?THEN WHY POTENT HORMONE 1% BOUND AFTER GNRH 1 IU/L •LH IS POTENT HORMONE
- 10. SO MANY BENEFITS?THEN WHY NATURAL CYCLE ANTAGONAGONIST •LH NEED IS DIFFERENT AT DIFFERENT DAYS
- 11. SO MANY BENEFITS?THEN WHY rec LH HMG rec FSH •MEDICATION AS A SOURCE
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- 15. Follicular recruitment thresholdconcept •
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- 17. Optimal level forfollicular deveopment LH THRESHOLD >.5 to 1 IU/l LH Ceiling >5 IU/l
- 18. Elevated LH levelsnegative art Regan et al 1990 Loumaye et al 2003 Stranger et al 1985 Watson et al 1993 Kolibanakis et al 2003
- 19. SUPPRESSED LH LEVELSNEGATIVE EFFECT Odea et al 2008 Lahound et al 2006 Flemming et al 1996 Westergarad et al 2000 Propst et al 2011.
- 20. 2 The LH TherapeuticWindow Concept • Follicular growth impaired • Inadequate androgen (and estrogen) synthesis • No full oocyte maturation LH threshold Normal follicular growth and development Normal androgen and estrogen biosynthesis Normal oocyte maturation Balasch J, Fábreques F. Curr Opin Obstet Gynecol 2002, 14:265-274 • Suppression of granulosa cell proliferation • Follicular atresia (nondominant follicles) • Premature luteinization (preovulatory follicle) • Oocyte development compromised LH ceiling
- 21. This is wherewe should be Therapeutic window
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- 23. ASIA PACIFIC LHADBOARD.
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- 25. Beneficial effect ofLH supplementation in ART Age • Marrs et al;Humaidan et al 2004 Initial poor responder Follicular stagnation • Ferrarettti et al; 2004 Low poor responders • Ruvolo et al. 2007 LH POLYMORPHISIM
- 26. Women > 35years: 26 The number of functional LH receptors decreases with age • Vihko et al,1996 Endogenous LH may become less potent or biologically active •Mitchell et al, 1995 The only group to benefit from LH supplementation with an increase in the number of mature eggs collected, improved implantation and pregnancy rates •Marrs et al, 2003; Humaidan et al, 2004
- 27. Poor responder Previous poorresponse less number of egg AMH AFC
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- 30. POOR RESPONDER HAVELOWER PROGNOSIS HYPO RESPONDER HAVE GOOD PROGNOSIS
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- 33. Hypo responder correctionwith LH Poseidon Group f&S 2016
- 34. How to identifythem
- 35. On going poorresponder add lh • BMI • age • afc with optimum dose • AFC good • But not many coming up lower rate of follicle growth • day 6 • day 8lower e2
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- 37. 37 LH and FSHAction on the Follicle Theca externa cells Theca interna cells Capillary network Basement membrane Cumulus Oophorus cells Oocyte Zona pellucida Granulosa cells Follicular antrum LH receptors on theca cells FSH receptors on granulosa cells E2 FSH LH A
- 38. LH polymorphism 1500patients 2012 -2016 312 position •wild •Heterozygous •homozygous 6 base pair insertion •heterozygous •homozygous
- 39. Studied 1500 coupleover a period of 4 years Found the following polymorphism relevant in INDIA Fshr 29 fshr 307 FSHR 680
- 40. Studied 1500 coupleover a period of 4 years Found the following polymorphism relevant in INDIA LHCGR 680 LHCGR 6 base insertion
- 41. LH polymorphism 312 position •wild •Heterozygous •homozygous NeedLH supplementation •heterozygous •homozygous
- 43. LH polymorphism These areknown cause for hypo response
- 44. Summary : Expected poorresponder •Hyp-oresponder •age >35 (agonist and antagonist) •GENETIC MUTATAION LOW LH ACTIVITY IN THECA & GRANULO CELLL
- 45. Summary Poor responder andhypo-responder are different •You can improve pregnancy rates •You identify in a current cycle •You can analyze from previous cycle
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