l3 key slides orvieto

10
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

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Page 1: 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

Page 2: L3 key slides orvieto
Page 3: L3 key slides orvieto

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

Page 4: L3 key slides orvieto

Methods to identify patients who may

benefit from LH supplementation?

Before COS

Poor responders & patients >35yrs

Mochtar et al 2007

Page 5: L3 key slides orvieto

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

Page 6: L3 key slides orvieto

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

Page 7: L3 key slides orvieto

Alviggi et al. 2006

‘Steady response’ (10-12%)

(De Placido et al, 2005)

Page 8: L3 key slides orvieto

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?

Page 9: L3 key slides orvieto

Progesterone elevation was associated with increased

number of COCs and E2 levels.

Intense stimulation

Page 10: L3 key slides orvieto

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