A prospective, randomized comparison of ovulation induction using highly purified follicle-stimulating hormone alone and with recombinant human luteinizing hormone in in-vitro fertilization

The commercial availabiIity of highly purified, s.c. administered urinary f ollicle stimulating hormone (FSH) preparations for ovarian stimulation mark ed the beginning of a new era in the treatment of infertility. As these new formulations contain essentially no luteinizing hormone (LH), supplemental LH may be needed for optimal folliculogenesis, It was the aim of this pilo t study to compare fertilization rates, embryo morphology, implantation rat es and pregnancy outcomes prospectively in two age-matched patient groups: women who received highly purified FSH (FSH-HP) (n = 17), and n omen who re ceived FSH-HP plus recombinant human LH (rhLH, n = 14) throughout ovarian s timulation, All patients received mid-luteal pituitary down-regulation with s.c, gonadotrophin-releasing hormone agonist (GnRHa) (leuprolide). Mean im plantation rates were 26.9 and 11.9% in the FSH-HP only and FSH-HP + rhLH g roups respectively. The mean clinical pregnancy/initiated cycle rate was 63 .7 and 35.7% for the FSH-HP only and FSH-HP + rhLH patients respectively, F SH-HP patients and FSH-HP + rhLH patients achieved clinical pregnancy/trans fer rates of 68.8 and 45.5 % respectively. One patient in the FSH-HP + rhLH group had a spontaneous abortion; no pregnancy losses occurred in the FSH- HP only group, There were more cancellations for poor ovarian response amon g FSH-HP + rhLH patients (n = 3) than among FSH-HP patients (n = 1). The tr end toward better pregnancy outcomes among patients who received FSH-HP wit hout supplemental rhLH did not reach statistical significance. It is postul ated that appropriate endogenous LH concentrations exist despite luteal GnR Ha pituitary suppression, thereby obviating the need for supplemental LH ad ministration.