title: The effect of rLH supplementation to the GnRH-antagonist protocol on endocrine dynamics in the advanced reproductive age.
abstract: OBJECTIVE
  To explore serum endocrine dynamics, specifically LH levels, following rLH supplementation to rFSH following GnRH-antagonist treatment in the advance reproductive age.
  
  
  METHODS
  Women were prospectively and similarly treated employing rFSH and the flexible GnRH-antagonist protocol, while rLH was supplemented only to the study group. Serum FSH, LH, E2,and P were evaluated throughout the follicular phase. Three strategies were a priori planned to examine endocrine dynamics among women enrolled.
  
  
  RESULTS
  While serum LH drop were similar before GnRH-antagonist stimulation, it dropped more times in the control group compared to the study group. Among women receiving rFSH only, serum LH levels dropped ≤2, ≤1 and ≤0.5 mIU/mL in 71.4, 46.4, and 28.6% of cases, while this occurred only in 38.7% (P = 0.01), 6.5% (P = 0.0004) and 3.2% (P = 0.007) of women receiving combined rFSH and rLH treatment, respectively. The same trend was found when serum LH dropped in at least two occasions following the GnRH-antagonist administration. Conversely, serum LH diagrams throughout the follicular phase did not differ between the two groups. Furthermore, individual area under the curve values of LH, E2,and P was similar between the two groups following GnRH-antagonist initiation.
  
  
  CONCLUSIONS
  Different strategies to explore LH dynamics following the GnRH-antagonist administration have resulted in diverse results, implying the need for a consensus definition of LH threshold for adequate folliculogenesis and steroidogenesis. Such action would pave the way for understanding which groups of patients may benefit from rLH supplementation.
authors.affiliation: Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, 15208, Tiberias, Israel. jyounis@poria.health.gov.il.|Faculty of Medicine in Galilee, Bar-Ilan University, Ramat Gan, Israel. jyounis@poria.health.gov.il.
authors.forename: J S
authors.initials: JS
authors.lastname: Younis
authors.affiliation: Department of Evolutionary and Environmental Biology, University of Haifa, Haifa, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Izhaki
authors.affiliation: Reproductive Medicine Unit, Department of Obstetrics and Gynecology, Poriya Medical Center, 15208, Tiberias, Israel.|Faculty of Medicine in Galilee, Bar-Ilan University, Ramat Gan, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Ben-Ami
mesh_terms: D000328:Adult; D004703:Endocrine System / Q000378:metabolism*; D004958:Estradiol / Q000378:metabolism*; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000378:metabolism*; D005498:Follicular Phase / Q000378:metabolism; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors*; D006727:Hormone Antagonists / Q000627:therapeutic use*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007986:Luteinizing Hormone / Q000008:administration & dosage*; D010062:Ovulation Induction; D011247:Pregnancy; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage*; D012098:Reproduction / Q000187:drug effects*
chemical_list: D006727:Hormone Antagonists; D011994:Recombinant Proteins; D007987:Gonadotropin-Releasing Hormone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone
keywords: Assisted reproductive technologies; LH threshold; Ovarian steroidogenesis; Serum LH dynamics