l3 key slides orvieto

Overview Role of LH during the natural

menstrual cycle

Methods to identify patients who may

benefit from LH supplementation?

Before COS

During COS

Type

Dose

Timing

Methods to identify patients who may

benefit from LH supplementation?

Before COS

During COH Hypogonadotropic hypogonadism

(The European Recombinant Human LH Study Group, 1998)

Follicular development can be achieved

with both LH+FSH and FSH alone,

BUT with FSH alone: • inadequate E2

• reduced occurrence of ovulation

• decreased endometrial thickness

• lower oocyte fertilization rates

LH

Methods to identify patients who may

benefit from LH supplementation?

Before COS

Poor responders & patients >35yrs

Mochtar et al 2007

Methods to identify patients who may

benefit from LH supplementation?

Before COS

Patients with high basal FSH/LH ratio

day 3 LH value <3 IU/L

day 3 FSH/LH ratio >3.6 predictive of a poor response to the long GnRH-agonist suppressive COS protocol. (Mukherjee 1996)

1996

Methods to identify patients who may

benefit from LH supplementation?

Before COS During COS

antagonist administration

gonadotropin administration

pre-treatment cycle treatment cycle

agonist administration

gonadotropin administration

Alviggi et al. 2006

‘Steady response’ (10-12%)

(De Placido et al, 2005)

During COS with GnRH-antagonist

Methods to identify patients who may

benefit from LH supplementation?

During COS

Is there any association between endogenous

LH and pregnancy in patients undergoing

COS with GnRH antagonist?

Progesterone elevation was associated with increased

number of COCs and E2 levels.

Intense stimulation

Methods to identify patients who may

benefit from LH supplementation

Before COS

During COS

- Hypogonadotropic hypogonadism

- Poor responders & patients >35yrs

- Patients with high basal FSH/LH ratio

GnRH-Agonist - Steady response - Patients with Day 8 LH>1.99. -Relative reduction in mid/late follicular LH concentrations.

GnRH-Antagonist - P>1-1.2 on day of hCG administration