Comparison of The Outcomes of rFSH Alone Versus rFSH + rLH Protocols in Patients Undergoing Controlled Ovarian Hyperstimulation for IVF Cycles

INTRODUCTION: Gonadotropin therapy is the mainstay of ovarian stimulation, while FSH is the main regulator of antral follicular growth, LH plays key roles in promoting steroidogenesis and in the development of the leading follicle. However, there is limited data on the use of LH supplementation in controlled ovarian stimulation for IVF. The aim of this prospective randomized study is to investigate the efficacy of the administration of rLH during COH in normogonadotrophic downregulated women, with initial normal - suboptimal ovarian response to monotherapy with rFSH. METHODS: Seventy seven patients were included in the study and two regimens, rFSH and rFSH + rLH, for IVF treatment of women with normal and decreased ovarian function were compared in prospective randomised fashion. Primary end-point of the study was the total number of metaphase II oocytes. RESULTS: Of the 77 patients, 39 received FSH alone (Group A) and 38 received FSH + LH (Group B). When all age groups were evaluated, number of metaphase II oocytes and total embryos were statistically significantly decreased in group B compared to groups A (p< 0.01). Particularly, in the subgroup of patients aged 35 years and over, number of metaphase II oocytes were statistically significantly decreased in group B compared to group A (p< 0.005). The number of good quality embryos and clinical pregnancy rates did not differ significantly between the two groups either in all age groups and patients aged ≥35. DISCUSSION and CONCLUSION: rFSH+rLH regimen appears not to be beneficial for the IVF treatment of women either with normal and decreased ovarian reserve. It should be considered however, to prove the efficacy, larger scale prospective randomized control trials should be conducted.

IVF Sikluslarında Kontrollü Ovaryen Hiperstimulasyonu Uygulanan Hastalarda Yalnız rFSH ile rFSH + rLH Kombinasyon Protokolleri Sonuçlarının Karşılaştırılması

GİRİŞ ve AMAÇ: Gonadotropin tedavisi, overyan stimülasyonun temelidir. FSH, antral folliküler büyümenin ana düzenleyicisi iken, LH ise steroidogenezin desteklenmesi ve antral follikül gelişiminde önemli rol oynar. Bununla birlikte, literatürde LH desteğinin, kontrollü ovaryan hiperstimülasyonuna eklenmesi hakkında sınırlı veri bulunmaktadır. Prospektif randomize çalışmamızın amacı, hipofizi baskılanmış normo-gonadotropik ve rFSH ile monoterapiye normal - suboptimal over cevabı olan kadınlarda kontrollü ovaryan hiperstimülasyon sırasında tedaviye rLH eklenmesinin etkinliğini araştırmaktır. YÖNTEM ve GEREÇLER: Çalışmaya yetmiş yedi hasta dahil edildi. IVF tedavisine alınan normal ve azalmış over fonksiyonuna sahip hastalar randomize edildi ve kontrollü overyan hiperstimülasyon esnasında, rFSH ile rFSH + rLH rejimleri prospektif olarak karşılaştırıldı. Çalışmanın birincil sonlanım noktası, toplam metafaz II oosit sayısı olarak kabul edildi. BULGULAR: Çalışmaya dahil olan yetmiş yedi hastadan otuz dokuzu, yalnız FSH (Grup A) ve otuz sekizi de FSH + LH (Grup B) aldı. Tüm yaş grupları içinde değerlendirildiğinde, grup B'de elde edilen metafaz II oosit ve toplam embriyo sayıları grup A'ya göre istatistiksel olarak anlamlı derecede azdı. Otuz beş yaş ve üstü hastalar ayrıca değerlendirildiğinde, metafaz II oosit sayısı, rFSH + rLH alan grupta istatistiksel olarak anlamlı derecede azalmış olarak saptandı. Hem tüm yaş gruplarındaki hastalar, hem de otuz beş yaş ve üstü hastalar değerlendirildiğinde iyi kalitede embriyo sayısı ve klinik gebelik oranları bakımından, her iki grup arasında istatistiksel olarak anlamlı farklılık izlenmedi. TARTIŞMA ve SONUÇ: Çalışmamızda, IVF tedavisinde rFSH + rLH rejiminin, hem normal hem de azalmış over rezervi olan kadınlarda faydalı olmadığı görülmektedir. Bununla birlikte, hasta sayısının daha fazla olduğu prospektif randomize kontrollü çalışmalarının yapılması gerektiğini düşünmekteyiz.

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