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Individualized treatment from theory to practice: the private case of adding LH during GnRH antagonist-based stimulation protocol.Shahar Kol, Maccabi Health Care ServicesRambam Health Care CampusTechnion, Israel Institute of Technology

Faculty DisclosureNo, nothing to disclose XYes, please specify: Company NameHonoraria/Expenses Consulting/ Advisory BoardFunded Research Royalties/ PatentStock OptionsEquity PositionOwnership/ EmployeeOther (please specify)Merck Serono IsraelxOff-Label Product Use

Will you be presenting or referencing off-label or investigational use of a therapeutic product? XNoYes, please specify:BackgroundLH is vital during the follicular phase.GnRH analogs are used to prevent premature LH rise, and untimely ovulation.GnRH analogs attenuate endogenous LH secretion.

Is exogenous LH needed? (1)GnRH agonist-based stimulation:Global LH supplementation is of no benefit.Advantage in LH-suppressed patients.Lisi et al. 2002Marrs et al. 2004040206080100LH level [U/L]DaysIs exogenous LH needed? (2)GnRH antagonist-based stimulation:Global LH supplementation is of no benefit

Konig et al. 2013040206080100LH level [U/L]DaysIs exogenous LH needed? (3)GnRH antagonist-based stimulation:Drop in LH concentration during antagonist treatment is associated with low pregnancy rate, with no relevance to the actual concentrations.

Huirne et al. 2005

What matters? Actual level or change?

Ganirelix dose finding study

Bad reproductive outcome with 1mg and 2 mg doses

Response to GnRH antagonist: Bell shapehypo-respondershyper-responders9OPTIMALH: Antagonist Luveris studyWho needs exogenous LH during ovarian stimulation after administration of a GnRH antagonist?

Objectives

What is the proportion of patients that sharply decrease their LH levels following the first GnRH antagonist 0.25 mg administration? Do these patients benefit from added LH?

Definition of GnRH antagonist hyper-responder: