MedWire News: Adding recombinant luteinizing hormone (LH) to assisted reproduction technology (ART) cycles may improve the chances of implantation and clinical pregnancy in women of advanced reproductive age, a study suggests.
Although a growing body of evidence has evaluated the use of recombinant LH in patients of advanced reproductive age (defined as ≥35 years), many of these trials had a small sample size, were underpowered for clinical pregnancy as a primary outcome, and were "inconclusive" as to the benefit of recombinant LH, say Eric Leven (National Institutes of Health, Bethesda, Maryland, USA) and colleagues.
To summarize the available evidence, they conducted a meta-analysis of seven trials that compared recombinant LH plus recombinant follicle-stimulating hormone (FSH) with recombinant FSH alone, in female ART patients aged 35 years or older.
The studies represented 902 ART cycles. Three studies were performed in patients of advanced reproductive age only, three reported advanced reproductive age as a subgroup analysis, and one reported on advanced reproductive age as an a priori age-adjusted analysis.
There was no difference in serum estradiol level on the day of human chorionic gonadotropin administration between either group in any of the trials. Two trials reported significantly lower oocyte yield in the recombinant LH group compared with the FSH-only group (means of 6.3 and 8.4 vs 7.9 and 10.1).
One trial reported a significantly lower metaphase II (MII) oocyte yield in the recombinant LH group compared with the FSH-only group, at 5.5 versus 6.9.
In fixed-effects analysis, the rate of implantation was a significant 36% higher in the recombinant LH-supplemented group than in the FSH-only group. The rate of clinical pregnancy was also significantly increased, by 37%, in the recombinant LH-supplemented group.
A repeat analysis of the data using a random effects model showed similar results, with a significant 35% increased rate of implantation in the recombinant LH patients, and a nonsignificant 36% increase in the rate of clinical pregnancy in the recombinant LH patients.
"The data from this study indicate a potential benefit to recombinant LH administration in patients of advanced reproductive age but no influence on oocyte or MII yield," write the authors.
They add that possible mechanisms for the improved implantation and clinical pregnancy rates seen in the study are increased oocyte competence or improved endometrial receptivity induced by LH addition. It is also possible that the administration of LH restores the follicular mileu of the developing follicle in older ART patients, they say.
"More studies are needed to determine whether this effect exists in both [gonadotropin-releasing hormone] agonist and antagonist protocols," Leven and team conclude in Fertility and Sterility.
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