The role of luteinizing hormone in the management of female infertility: A French Delphi consensus

Abstract

Purpose: To clarify clinical practice with regard to LH requirements and identify patient profiles that could benefit from luteinizing hormone (LH)-follicle-stimulating hormone co-treatment. Methods: In a Delphi survey, a scientific advisory board elaborated 28 statements on the role of luteinizing hormone (LH) in folliculogenesis (n = 7 statements), the utility of LH for follicular development prior to ovulation induction/intrauterine insemination protocols (n = 3), the utility of LH for follicular development prior to agonist or pretreated antagonist protocols in IVF (n = 6), the source and type of LH activity (n = 3), and patient profiles (n = 9). These statements were reviewed and clarified by two pilot experts. A panel of 26 French ART experts voted in two rounds. Full consensus and consensus were defined respectively as 100% and > 66% agreement. Statements could be reformulated between the two rounds of voting. Results: A full consensus or a consensus was reached for 24 of the 28 statements. All the statements concerning the pathophysiological role of LH in folliculogenesis achieved a consensus. The experts endorsed the basic science and emphasized the need to consider inter-individual variability in the clinic. Recombinant human LH was considered to optimize outcomes in a range of patient profiles: a suboptimal ovarian response to IVF stimulation, desensitization following a long agonist protocol, advanced maternal age (> 35), polymorphisms, low body mass index, and women with hypogonadotropic hypogonadism. Conclusions: This Delphi consensus from a representative group of French experts provided real-world guidance on LH’s crucial importance in folliculogenesis and the patient profiles for which LH is beneficial.