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L3 key slides orvieto

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L3 key slides orvieto

  1. 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
  2. 2. 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
  3. 3. Methods to identify patients who may benefit from LH supplementation? Before COS Poor responders & patients >35yrs Mochtar et al 2007
  4. 4. 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
  5. 5. 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
  6. 6. Alviggi et al. 2006 ‘Steady response’ (10-12%) (De Placido et al, 2005)
  7. 7. 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?
  8. 8. Progesterone elevation was associated with increased number of COCs and E2 levels. Intense stimulation
  9. 9. 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

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