Effects of recombinant human luteinizing hormone supplementation on ovarian stimulation and the implantation rate in down-regulated women of advanced reproductive age

Objective: To evaluate the effects of recombinant human luteinizing hormone (rhLH) supplementation on ovarian stimulation and implantation rate in down-regulated women of advanced reproductive age. Design: Prospective randomized study. Setting: University teaching hospital. Patient(s): A total of 120 consecutive normogonadotropic infertile women 2:35 years old undergoing their first cycle of IVF or intracytoplasmic sperm injection (ICSI) treatment. Intervention(s): Ovarian stimulation in a long agonist protocol with a combination of recombinant human follicle-stimulating hormone (rhFSH) and rhLH (group 1, n = 60) starting on day 6 of FSH stimulation until hCG at a daily fixed dose of 150 IU of rhLH, or with rhFSH alone (group 2, n = 60). Main Outcome Measure(s): Ovarian stimulation characteristics, ovum retrieval, and IVF/ICSI outcome. Result(s): The mean number of intermediate (10-14 min) and large (> 14-< 18 mm) but not leading (>= 18 mm) follicles was significantly lower in group I on the day of hCG injection. The oocyte yield and maturity as well as the number of oocytes fertilized were significantly higher in group 2 than in group 1. However, the number of patients having embryo transfer (n = 55 in both treatment groups), the number and quality of embryos replaced, the implantation rate (20.6% vs. 21.7%) and clinical pregnancy rates per embryo transfer (44% vs. 45%) were similar in groups 1 and 2. Conclusion(s): The rhLH supplementation does not increase ovarian response and implantation rates in patients of older reproductive age stimulated with rhFSH under pituitary suppression for assisted reproductive technologies (ART's).