THE ROLE OF LUTEINIZING-HORMONE IN HUMAN FOLLICLE DEVELOPMENT AND OOCYTE FERTILITY - EVIDENCE FROM IN-VITRO FERTILIZATION IN A WOMAN WITH LONG-STANDING HYPOGONADOTROPIC HYPOGONADISM AND USING RECOMBINANT HUMANFOLLICLE-STIMULATING-HORMONE

To evaluate the relative importance of follicle stimulating hormone (F SH) and luteinizing hormone (LH) in follicular development and oocyte fertility in the human species, the use of recombinant human FSH, huma n menopausal gonadotrophin (HMG), and very highly purified urinary hum an FSH (FSH-HP) plus oestradiol valerate for ovarian stimulation and i n-vitro fertilization (IVF) were compared in three cycles in a woman w ith isolated congenital gonadotrophin deficiency who had never been tr eated with ovarian stimulating agents, The total number of ampoules of gonadotrophins used was lower in the HMG treatment cycle, Ovarian res ponse and IVF outcome in the three treatment cycles were as follows: ( i) HMG cycle: normal follicular growth, normal pattern of oestradiol a nd inhibin through the menstrual cycle, high fertilization rate (93%); (ii) recombinant FSH cycle: normal follicular growth, low oestradiol and abnormal inhibin, finally poor rate of fertilization (28%); (iii) FSH-HP plus oestradiol valerate cycle: normal follicular growth, norma l pattern of inhibin and poor fertilization rate (27%). Luteal plasma progesterone concentrations were much higher in the HMG treatment cycl e, This case shows that FSH is the only factor required in order to in duce follicular growth in the human, although LH or a product derived from its action may assist in order to achieve full follicular maturit y and oocytes capable of fertilization. Though oestradiol might have a mediatory role in the process of follicular maturation, our results f avour a direct primary role of LH in complete maturation of the follic le.