The effect of recombinant LH on embryo quality: A randomized controlled trial in women with poor ovarian reserve

Abstract

BACKGROUND: Poor ovarian response is a common clinical problem, affecting up to 26 of IVF cycles. For these women, addition of recombinant luteinizing hormone (rLH) to ovarian hyperstimulation with recombinant FSH has a beneficial effect on ongoing pregnancy rates, but its effect on the yield of top-quality embryos is unknown. METHODS: We conducted a randomized controlled trial in women expected to respond poorly under ovarian hyperstimulation during their first IVF cycle [all women aged 3541 and women with FSH > 12 IU/ml and antral follicle count (AFC) ≤ 5]. Women were randomly allocated to rFSH and rLH (2:1 ratio) or rFSH alone (control group) after down-regulation with a GnRH agonist. The primary outcome was the proportion of top-quality embryos per woman on the day of transfer. Secondary outcomes were the number of stimulation days, the number of follicles <17 mm, the number of oocytes, the fertilization rate, the number of embryos, the number of women with <1 top-quality embryo, the biochemical, clinical and ongoing pregnancy rates and the miscarriage rate. RESULTS: There were 116 women allocated to the rLH group and 128 allocated to the control group. The proportion of top-quality embryos per woman was 17 in the rLH group and 11 in the control group [mean difference 0.06; 95 confidence interval (CI) -0.010.14]. In the rLH and control groups respectively, 47 (41) and 41 (32) women had at least one top-quality embryo on the day of transfer (relative risk: 1.3, 95 CI 0.911.77). The ongoing pregnancy rate was 13 versus 12 (relative risk: 1.1; 95 CI 0.572.16) for the rLH group compared with the control group. CONCLUSIONS: This study found no significant difference in embryo quality after the addition of rLH to rFSH for ovarian stimulation in women with poor ovarian reserve. © The Author 2011.