Recombinant LH administration in subsequent cycle after “unexpected” poor response to recombinant FSH monotherapy.

Abstract

Poor ovarian response (POR) is most frequently linked to the condition known as diminished ovarian reserve, but it can also occur in the absence of pathological ovarian reserve tests (“unexpected” POR). Because possible explanations include theca cells function deficiency, our aim was to evaluate the effect of r-LH administration in “unexpected” poor responders.

A retrospective, single-centre, cohort study was conducted on 65 patients with AMH >0.5 ng/ml and/or AFC >5 with POR in their first cycle. Patients underwent a second IVF cycle with same protocol (long- or antagonist) and same starting dose of r-FSH used in the first cycle, plus daily addiction of 150 IU of r-LH from day 1.

Compared to the first cycle, r-LH addition in the second cycle determined an increase in number of oocytes retrieved (p < 0.001), number of metaphase II oocytes (p < 0.05), E₂ levels at hCG triggering (p < 0.001) and number of embryos transferred (p = 0.002). A 15% clinical pregnancy rate was also observed in the second cycle.

Our results suggest that patients with non-pathological ovarian reserve tests and previous “unexpected” POR seem to benefit from r-LH addition in subsequent cycles without the need to increase the r-FSH starting dose, possibly due to an underlying occult theca cells deficiency.

Chinese abstract

卵巢低反应常常与卵巢储备功能下降的情况相关，但是它也会发生在卵巢储备正常的情况下（即所谓的“非预料”卵巢低反应POR）。由于有人认为这种卵巢低反应与卵泡膜细胞的功能缺陷有关，因此，我们的研究是评估在IVF中给予这部分患者重组LH的治疗效果。

这是一项回顾性、单中心的队列研究， 65名抗苗勒氏管激素AMH>0.5ng/ml和/或窦卵泡数AFC>5患者.，在IVF的第一个周期呈现卵巢低反应。在随后的第二个周期采用与第一个周期相同的方案（GnRH拮抗剂长方案）以及相同的FSH的起始应用剂量，同时从第一天开始每天加用150IU的重组LH。与第一个周期不同的是，第二个周期重组LH的给予增加了获卵数(p<0.001)，卵母细胞成熟率(p<0.05)，HCG诱发排卵时的雌二醇的水平(p<0.001)以及移植的胚胎数量(p=0.002)，在第二个周期获得了15%的临床妊娠率。

我们的研究结果提示，在IVF的治疗中，对于那些可能存在潜在的卵泡膜细胞功能缺陷的患者，其卵巢储备功能正常但是却出现卵巢低反应，在随后的治疗周期中加用重组LH，而不需要增加重组FSH的初始剂量，看起来是有效果的。

• Controlled ovarian stimulation
• poor ovarian response
• recombinant LH
• theca cells