Introduction: With IVF stimulation a premature pituitary LH surge can ruin the whole procedure. Traditionally prevention of this event is done by administering a GnRH antagonist against endogenous hypothalamic GnRH. The obvious consequence is low LH levels, one of the two gonadotrophines usually not given for ovarian stimulation since for adequate action FSH suffices. However there are indications that LH levels may render too low, in particular in older women. The aim of this study was to investigate whether the addition of LH to an IVF stimulation protocol with FSH and GnRH antagonist will improve the ovarian response and consequently, implantation and pregnancy rates in women of 35 years and older.
Methods: A prospective randomized multicentre study was performed in couples who were undergoing IVF/ICSI. Women were 35 years or older and received ovarian stimulation with FSH and GnRH antagonist from day 6 of stimulation. Randomization took place on day 6 of stimulation to receive both FSH and LH or continue with FSH alone. Primary endpoint of the study was implantation rate (the chance of an embryo to implant) and clinical pregnancy rate (defined as a pregnancy diagnosed by ultrasonographic visualisation of at least one gestational sac).
Results: Of 249 subjects randomized, 128 received both FSH and LH and 121 received only FSH. There were no demographic or clinical differences between the groups. Intention to treat analysis revealed that of those receiving FSH and LH, 33 (27.5%) had an clinical pregnancy, compared with 38 (30.6%) receiving only FSH (P=0.6). Implantation rates were similar: 17.2 vs 21.1% (P=0.4) in the FSH and LH and FSH only groups respectively.
Conclusions: Our study shows that replenishment of low hypothalomo-pituitary regulation of LH is not crucial for ovarian response in IVF in older women.
30 Apr - 04 May 2011
European Society of Endocrinology