Luteinizing hormone supplements and ovarian stimulation: Timing is everything?

This study looked at the potential benefit of introducing luteinizing hormone (LH) earlier during ovarian stimulation in older women. Starting LH on the earlier date was shown to increase clinical pregnancy rates.

There is an increased number of older women (over 35) seeking help to get pregnant. Success rates usually decline as age increases. Ovarian stimulation is a procedure that increases egg production with the help of medication.

Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are hormones in the body that help regulate egg production (ovulation) and a woman's menstrual cycle.

The role of LH in assisted reproduction is not conclusive. Added to FSH, it may benefit older women undergoing ovarian stimulation. It is usually started around day six of FSH stimulation.

In this study, women aged 36-40 years were randomly placed into two groups. Group A comprised 103 women who were given FSH and LH from day one. Group B comprised 99 women who were given FSH from day one, and FSH with LH from day six.

The main objective of the study was to see if there was the same number of egg cells stimulated in each group. The study concluded that the number of egg cells in each group was different.

In group A, the rate of implantation was 24.7%, compared to 13.3% in group B.  Clinical pregnancy rates per cycle were 31.6% in group A and 17.2% in group B.

The study concluded that taking LH earlier in ovarian stimulation may be associated with increased pregnancy rates in older women.

The main objective of the study was not met, and the study was not powered to compare secondary outcomes. Further trials with a larger number of patients is required.

 The study did not explore the optimal day to start LH. The patients in this study were undergoing GnRH (gonadotropin-releasing hormone) agonist cycles.

If you are over 35 and are considering ovarian stimulation to help you get pregnant, you should discuss with your physician the potential benefits of using LH earlier in the process.