Application of Exogenous Luteinizing Hormone in IVF Patients of Late Reproductive Age

Abstract

Background: A decreased concentration of luteinizing hormone (LH) in women of late reproductive age contributes to disorder in adequate steroidogenesis and impairs oocyte/embryo quality, which results in fewer embryos suitable for cryopreservation, a lower implantation rate, and increased rate of early miscarriage. The purpose of our study was a retrospective analysis of the effectiveness of applying exogenous LH (urinary and recombinant) in ART programs in women of late reproductive age with previous IVF failures. Methods and Results: We studied how adding exogenous LH (urinary and recombinant) from Days 2-3 and 6-7 of menstrual cycle in ovulatory stimulation affects the outcomes of in vitro fertilization cycles. The study included 324 women (mean age of 35.7±3.8 years) receiving treatment for tubal¬-peritoneal infertility as part of IVF programs. All patients were divided into 4 groups depending on the stimulation day (Day 2-3 or Day 6-7) when exogenous LH-based inductor (human menopausal gonadotropin or recombinant LH) was added. In patients with a risk of "poor response," supplementing rLH at the initial stages of folliculogenesis (Day 2-3 of menstrual cycle) promotes optimization of oogenesis processes, obtaining a high percentage of good quality embryos (78%) and increasing pregnancy rate (30%). The good quality frozen embryos obtained in stimulation with recombinant LH and human menopausal gonadotropin added, had the same good quality and provided the PR comparable to transfer of fresh embryos. Conclusion: It is possible that LH injection restores the microenvironment of developing follicles in women of late reproductive age, which is reasonable for the patients studied.

Keywords

• in vitro fertilization
• exogenous luteinizing hormone
• pregnancy
• embryo cryopreservation