title: 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 35-41 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) -0.01-0.14]. 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 0.91-1.77). The ongoing pregnancy rate was 13 versus 12% (relative risk: 1.1; 95% CI 0.57-2.16) 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.
  
  
  BACKGROUND
  NTR1457.
authors.affiliation: Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology (H4-205), Academic Medical Centre, University of Amsterdam, PO Box 22700, Amsterdam 1100 DE, The Netherlands. a.m.musters@amc.uva.nl
authors.forename: A M
authors.initials: AM
authors.lastname: Musters
authors.forename: M
authors.initials: M
authors.lastname: van Wely
authors.forename: S
authors.initials: S
authors.lastname: Mastenbroek
authors.forename: E M
authors.initials: EM
authors.lastname: Kaaijk
authors.forename: S
authors.initials: S
authors.lastname: Repping
authors.forename: F
authors.initials: F
authors.lastname: van der Veen
authors.forename: M H
authors.initials: MH
authors.lastname: Mochtar
mesh_terms: D000022:Abortion, Spontaneous; D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D005640:Follicle Stimulating Hormone / Q000378:metabolism; D006801:Humans; D007986:Luteinizing Hormone / Q000378:metabolism; D006080:Ovarian Follicle / Q000166:cytology; D010053:Ovary / Q000187:drug effects* / Q000378:metabolism / Q000502:physiology*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012306:Risk
chemical_list: D011994:Recombinant Proteins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone