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Hum. Reprod. Advance Access originally published online on January 21, 2005
Human Reproduction 2005 20(5):1200-1206; doi:10.1093/humrep/deh741
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions{at}oupjournals.org

Recombinant luteinizing hormone supplementation to recombinant follicle-stimulating hormone induced ovarian hyperstimulation in the GnRH-antagonist multiple-dose protocol

G. Griesinger1, A. Schultze-Mosgau, K. Dafopoulos, A. Schroeder, A. Schroer, S. von Otte, D. Hornung, K. Diedrich and R. Felberbaum

University Clinic of Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, 23858 Luebeck, Germany

1 To whom correspondence should be addressed: Email: georg.griesinger{at}frauenklinik.uni-luebeck.de

BACKGROUND: Suppression of endogenous LH production by mid-follicular phase GnRH-antagonist administration in controlled ovarian hyperstimulation protocol using recombinant (rec) FSH preparations void of LH activity may potentially affect ovarian response and the outcome of IVF treatment. The present study prospectively assessed the effect of using a combination of recFSH and recLH on ovarian stimulation parameters and treatment outcome in a fixed GnRH-antagonist multiple dose protocol. METHODS: 127 infertile patients with an indication for IVF or ICSI were recruited and randomized (using sealed envelopes) to receive a starting dose of either 150 IU recFSH (follitropin {alpha}) or 150 IU recFSH plus 75 IU recLH (lutropin {alpha}) for ovarian hyperstimulation. GnRH-antagonist (Cetrorelix) 0.25 mg was administered daily from stimulation day 6 onwards up to and including the day of the administration of recombinant HCG (chorion gonadotropin {alpha}). Gonadotropin dose adjustments were allowed from stimulation day 6 onwards, HCG was administered as soon as three follicles ≥18 mm were present. The primary outcome parameter was treatment duration until administration of HCG. RESULTS: Exogenous LH did not shorten the time necessary to reach ovulation induction criteria. Serum estradiol (E2) and LH levels were significantly higher on the day of HCG administration in the recLH-supplemented group (1924.7 ± 1256.4 vs 1488.3 ± 824.0 pg/ml, P<0.03), and 2.1 ± 1.4 vs 1.4 ± 1.5 IU/l, P<0.01, respectively). CONCLUSIONS: Except for higher E2 and LH levels on the day of HCG administration, no positive trend in favour of additional LH was found as defined by treatment outcome parameters.

Key words: cetrorelix/GnRH-antagonist/ovarian stimulation/recombinant FSH/recombinant LH


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