Exogenous luteinizing hormone for assisted reproduction techniques in poor response patients

Abstract

Background/Aim. Two gonadotrophins, two cell theory refers to necessity of both gonadotrophin activities for theca and granulose cells steroidogenesis of dominant follicle. The aim of this study was to determine the influence of recombinant LH in women qualified as poor responders in the first assisted reproduction procedure (IVF), on fertility results, expressed as percentage of clinical pregnancies. Method. The study included 12 women, 35 years and older who were their own controls. The next trial of IVF was with the same dose of recombinant FSH and GnRH agonist, and with the same, long protocol. Recombinant LH was added in the dose of 75 IU from the 2nd to 7th day of the cycle, and 150 IU from the 8th day of the cycle to the aspiration of oocytes. Results. Within the two different protocols: there was no significant difference between LH concentration in 8th and 12th day of cycle; there was no significant difference between E2 concentration on day 2nd and day 8th; there was a significant difference between E2 concentrations on day 12th; endometrial thickness was not significantly different on the day of aspiration, neither was the number of follicles and embryos. In the two patients, clinical pregnancy was detected (pregnancy rate 17%), and they delivered in term. So, a statistically significant difference between the two protocols was in the rate of clinical pregnancies. Conclusion. The patients with low response to a long protocol in IVF procedures had significantly better results according to the clinical pregnancy rate when the recombinant LH was added to recombinant FSH in the stimulation protocol.Uvod/Cilj. Teorija 'dva gonadotropina, dve celije' govori o neophodnom prisustvu oba gonadotropina u toku steroidogeneze u teka i granuloza celijama dominantnog folikula. Cilj rada bio je da se utvrdi da li kod zena sa losim odgovorom u postupku vantelesne oplodnje (IVF) promena protokola stimulacije ovulacije - dodavanje rekombinantnog luteinizirajuceg hormona (LH), utice na stopu klinickih trudnoca. Metode. U ovu studiju bilo je ukljuceno 12 zena starijih od 35 godina koje su prema prvom postupku vantelesne oplodnje spadale u grupu sa slabim odgovorom. Bolesnice su bile same sebi kontrola s obzirom na to da u novom pokusaju nije povecavan ukupan broj jedinica rekombinantnog folikolostimulirajuceg hormona (FSH); primenjen je isti, dugi protokol sa istom dozom analoga; rekombinantni LH dodat je u novom pokusaju u dozi od 75 IU dnevno od 1. do 7. dana ciklusa i 150 IU/L dnevno od 8. dana ciklusa do aspiracije. Rezultati. U toku dva razlicita protokola stimulacije: vrednosti LH 8. i 12. dana ciklusa nisu se znacajno razlikovale; nije pronadjena znacajna razlika niti bazalnih niti vrednosti E2 8. dana ciklusa; pronadjena je visoko statisticki znacajna razlika u vrednostima E2 12. dana ciklusa; debljina endometrijuma nije se statisticki znacajno razlikovala kod dva protokola, kao ni broj folikula i embriona (p > 0,05). Kod dve bolesnice (17%) doslo je do klinicke trudnoce i terminskog porodjaja (statisticki znacajna razlika). Zakljucak. Bolesnice sa pocetno losim odgovorom u toku dugog protokola stimulacije ovulacije u postupku vantelesne oplodnje imaju znacajno poboljsanje uspeha postupka, posmatrano u odnosu na procenat klinickih trudnoca i porodjaja, kada se u protokol stimulacije ovulacije rekombinantnom FSH doda rekombinantni LH.