Skip to main content
SpringerLink
Log in

Clinical Assisted Reproduction: The Effect of Exogenous Luteinizing Hormone (LH) on Oocyte Viability: Evidence from a Comparative Study Using Recombinant Human Follicle-Stimulating Hormone (FSH) Alone or in Combination with Recombinant LH for Ovarian Stimulation in Pituitary-Suppressed Women Undergoing Assisted Reproduction

  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose: The purpose of this prospective, randomized study was to compare ovarian response and oocyte and embryo yields in women undergoing ovulation induction for IVF/ICSI using recombinant human FSH (rhFSH) alone or in combination with recombinant human LH (rhLH).

Methods: Patients were randomized to receive rhFSH alone (group F; n = 13) or rhFSH + rhLH (group L; n = 15). rhFSH was administered according to a step-down protocol; patients assigned to group L received rhLH at a fixed dose of 75 IU (1 ampoule) throughout the treatment period.

Results: The total dose of rhFSH, number of growing follicles, and serum concentrations of estradiol (E2) on the day of hCG administration were similar in both treatment groups. However, the percentage of metaphase II oocytes and fertilization rate were significantly higher in group F than in group L. The lower fertilization rates associated with rhLH were also seen in a subgroup of patients from group L who had undergone a previous ART cycle stimulated with FSH only and thus acted as their own controls. However, when in vitro fertilization (IVF) and intracytoplasmic sperm injection cycles were considered separately, differences in fertilization rates were statistically significant only for oocytes treated by conventional IVF.

Conclusions: This study shows that the addition of recombinant LH to recombinant FSH in pituitary-suppressed women undergoing ART does not improve the ovarian response and even may have a negative impact on oocyte maturation and fertilization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Filicori M: Gonadotropin-releasing hormone analogs in ovulation induction: currents status and perspectives. J Clin Endocrinol Metab 1996;81:2413-2416

    Google Scholar 

  2. Lunenfeld B, Lunenfeld E: Gonadotropic preparations-Lessons learned. Fertil Steril 1997;67:812-814

    Google Scholar 

  3. Hull MGR, Armatage RJ, McDermott A: Use of follicle-stimulating hormone alone (urofollitropin*) to stimulate the ovaries for assisted conception after pituitary desensitization. Fertil Steril 1994;62:997-1003

    Google Scholar 

  4. Loumaye E, Engrand P, Howles CM, et al.: Assessment of the role of serum luteinizing hormone and estradiol response to follicle-stimulating hormone on in vitro fertilization outcome. Fertil Steril 1997;67:889-899

    Google Scholar 

  5. Daya S: hMGversus FSH: Is there any difference? In Ovulation Induction: Update' 98, M Filicori, C Flamigni (eds). New York, Parthenon Publishing Group, 1998, pp 183-192

    Google Scholar 

  6. Söderström-Anttila V: Clinical outcome of ovulation induction: highly purified FSH versus hMG. In Ovulation Induction: Update' 98, M Filicori, C Flamigni (eds). New York, Parthenon Publishing Group, 1998, pp 193-200

    Google Scholar 

  7. Filicori M: The role of luteinizing hormone in folliculogenis and ovulation induction. Fertil Steril 1999;71:405-414

    Google Scholar 

  8. Chappel SC, Howles C: Reevaluation of the roles of luteinizing hormone and follicle-stimulating hormone in the ovulatory process. Hum Reprod 1991;6:1206-1212

    Google Scholar 

  9. Fleming R, Chung CC, Yates RWS, et al.: Purified urinary follicle stimulating hormone induces different hormone profiles compared with menotrophins, dependent upon the route of administration and endogenous luteinizing hormone activity. Hum Reprod 1996;11:1854-1858

    Google Scholar 

  10. Pieters MHEC, Dumoulin JCM, Engelhart CM, et al.: Immaturity and aneuploidy in human oocytes after different stimulation protocols. Fertil Steril 1991;56:306-310

    Google Scholar 

  11. Balasch J, Fábregues F, Creus M, et al.: Pure and highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotrophin for ovarian stimulation after pituitary suppression in in-vitro fertilization. Hum Reprod 1996;11:2400-2404

    Google Scholar 

  12. The European Recombinant Human LH Study Group: Recombinant human luteinizing hormone (LH) to support recombinant human follicle-stimulating hormone (FSH)-induced follicular development in LH-and FSH-deficient anovulatory women: a dose-finding study. J Clin Endocrinol Metab 1998;83:1507-1514

    Google Scholar 

  13. Veeck LL: Atlas of the Human Oocyte and Early Conceptus. Baltimore, Williams & Wilkins, 1986

    Google Scholar 

  14. Jacobson A, Marshall JR: Ovulatory response rate with human menopausal gonadotropins of varying FSH-LH ratios. Fertil Steril 1969;20:171-175

    Google Scholar 

  15. Louwerens B: The clinical significance of the FSH/LH ratio in gonadotropin preparations of human origin. A review. Acta Obstet Gynecol Scand 1969;48 (Suppl 1):31-40

    Google Scholar 

  16. Balasch J, Miró F, Burzaco I, et al.: The role of luteinizing hormone in human follicle development and oocyte fertility: Evidence from in-vitro fertilization in a woman with long-standing hypogonadotrophic hypogonadism and using recombinant human follicle stimulating hormone. Hum Reprod 1995; 10:1678-1683

    Google Scholar 

  17. Fox R, Ekeroma A, Wardle P: Ovarian response to purified FSH in infertile women with long-standing hypogonadotropic hypogonadism. Aust NZ J Obstet Gynaecol 1997;37:92-94

    Google Scholar 

  18. Cortvrindt R, Hu Y, Smitz J: Recombinant luteinizing hormone as a survival and differentiation factor increases oocyte maturation in recombinant follicle stimulating hormone-supplemented mouse preantral follicle culture. Hum Reprod 1998;13:1292-1302

    Google Scholar 

  19. Hillier SG: Current concepts of the roles of follicle stimulating hormone and luteinizing hormone in folliculogenesis. Hum Reprod 1994;9:188-191

    Google Scholar 

  20. Zelinski-Wooten MB, Hutchinson JS, Hess DL, et al.: Follicle stimulating hormone alone supports follicle growth and oocyte development in gonadotrophin-releasing hormone antagonist-treated monkeys. Hum Reprod 1995;10:1658-1666

    Google Scholar 

  21. Weston AM, Zelinski-Wooten MB, Hutchinson JS, et al.: Developmental potential of embryos produced by invitro fertilization from gonadotrophin-releasing hormone antagonist-treated macaques stimulated with recombinant human follicle stimulating hormone alone or in combination with luteinizing hormone. Hum Reprod 1996;11:608-613

    Google Scholar 

  22. Kelly EE, Nebiolo L: Recombinant FSH therapy alone versus combination therapy with recombinant LH therapy in patients down-regulated with a low-dose luteal GnRH agonist protocol: Preliminary results. In Towards Reproductive Certainty: Fertility & Genetics Beyond 1999, R Jansen, D Mortimer (eds). New York, Parthenon Publishing Group, 1999, pp. 200-204

    Google Scholar 

  23. Sills ES, Levy DP, Moomjy M, et al.: A prospective, randomized comparison of ovulation induction using highly purified follicle-stimulating hormone alone and with recombinant human luteinizing hormone in in-vitro fertilization. Hum Reprod 1999;14:2230-2235

    Google Scholar 

  24. Bukovsky A, Chen TT, Wimalasena J, et al.: Cellular localization of luteinizing hormone receptor immunoreactivity in the ovaries of immature, gonadotropin-primed and normal cycling rates. Biol Reprod 1993;48:1367-1382

    Google Scholar 

  25. Schreiber JR, Reed R, Ross GT: A receptor-like testosterone-binding protein in ovaries from estrogen-stimulated hypophysectomized immature female rats. Endocrinology 1976;98:1206-1213

    Google Scholar 

  26. Erickson GF, Magoffin DA, Dyer CA, et al.: The ovarian androgen producing cells: A review of structure/function relationships. Endocrin Rev 1985;6:371-399

    Google Scholar 

  27. Rodgers M, McLoughlin J, Peers N, et al.: Accumulation of human chorionic gonadotrophin in the serum of patients during in-vitro fertilization treatment cycles with Pergonal. Hum Reprod 1994;9:638-642

    Google Scholar 

  28. Eshkol A: Recombinant gonadotrophins: An introduction. Hum Reprod 1996;11 (Suppl 1):89-94

    Google Scholar 

  29. Siebold B: Physicochemical characterization of recombinant human follicle stimulating hormone. Hum Reprod 1996;11 (Suppl 1):109-115

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine—, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Juan Balasch, Montserrat Creus, Francisco Fábregues, Salvadora Civico, Francisco Carmona, Bienvenido Puerto & Juan A. Vanrell

  2. Hormonal Laboratory, Faculty of Medicine—, University of Barcelona, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    Roser Casamitjana

Authors
  1. Juan Balasch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Montserrat Creus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francisco Fábregues
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Salvadora Civico
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco Carmona
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bienvenido Puerto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Roser Casamitjana
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Juan A. Vanrell
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balasch, J., Creus, M., Fábregues, F. et al. Clinical Assisted Reproduction: The Effect of Exogenous Luteinizing Hormone (LH) on Oocyte Viability: Evidence from a Comparative Study Using Recombinant Human Follicle-Stimulating Hormone (FSH) Alone or in Combination with Recombinant LH for Ovarian Stimulation in Pituitary-Suppressed Women Undergoing Assisted Reproduction. J Assist Reprod Genet 18, 250–256 (2001). https://doi.org/10.1023/A:1016662100572

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1016662100572

Search

Navigation