RESUMEN
Twelve patients (17 cycles) who needed >3000 IU of recombinant FSH (rFSH) on previous follicular stimulation attempts for IVF using rFSH (group A) underwent further attempts (a total of 12 cycles) using rFSH supplemented with rLH from day 7 of stimulation (group B). There was no significant difference in the total quantitative administration of rFSH (mean: 4759 versus 4800 IU rFSH), days of stimulation (14.0 versus 12.6), number of M2 oocytes per patient (3.76 versus 4.17) or embryo morphology between group A and group B respectively. However, there was a significant increase in the incidence of fertilization (60.9 versus 86.0%; P = 0.006) and clinical (ongoing) pregnancies (1 versus 6; P = 0.022). The higher incidence of fertilization increased the mean number of embryos transferred per patient, although in this small group the data was not significant (1.75 versus 2.71). This preliminary clinical trial suggests that in poor responders superimposing rLH upon a down-regulated cycle stimulated with rFSH improves relevant outcome data; and this preliminary trial has encouraged the need for a larger and more detailed study.
RESUMEN
The aim of this study was to evaluate the use of recombinant luteinizing hormone (rLH) supplementation in an unselected group of IVF patients undergoing follicular stimulation with recombinant follicle stimulating hormone (rFSH) after pituitary down-regulation. Group A comprised 122 cycles administered rFSH and rLH while group B included 331 cycles using rFSH only during the same period of treatment. There was no significant difference in any of the endocrine, embryological and outcome parameters measured. The implantation rate of 14.2% for group A compared with 9.8% for group B showed a positive trend (P = 0.055), but for patients in whom LH concentration was <1.0 IU/l at down-regulation or required excessive FSH stimulation, there was an increased incidence of implantation if rLH was supplemented. It was concluded that the addition of exogenous rLH to an unselected group of 'down-regulated' patients stimulated with rFSH appears to offer little benefit, but in the event of profound LH down-regulation or requirement for excessive exogenous FSH (>2500 IU), the rate of implantation might be improved.