title: Recombinant LH administration in subsequent cycle after "unexpected" poor response to recombinant FSH monotherapy.
abstract: 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.
authors: Obstetrics and Gynaecology Department, Centro Scienze della Natalità, Ospedale San Raffaele , Milan , Italy .
authors: Enrico
authors: E
authors: Papaleo
authors: Valeria Stella
authors: VS
authors: Vanni
authors: Paola
authors: P
authors: Viganò
authors: Antonio
authors: A
authors: La Marca
authors: Luca
authors: L
authors: Pagliardini
authors: Rossella
authors: R
authors: Vitrano
authors: Mara
authors: M
authors: Zanirato
authors: Elena
authors: E
authors: Marsiglio
authors: Laura
authors: L
authors: Privitera
authors: Massimo
authors: M
authors: Candiani
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007986:Luteinizing Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D009865:Oocytes / Q000187:drug effects*; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: Controlled ovarian stimulation; poor ovarian response; recombinant LH; theca cells