A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome

Objective: To determine the effect of exogenous LH dosage on IVF outcome. Design: Single-blinded (assessor-blinded) study with random assignment of t reatment groups. Setting: Human Assisted Reproduction Unit, Rotunda Hospital, Dublin, Irelan d. Patient(s): Infertile normogonadotropic women undergoing their first cycle of IVF were studied. Intervention(s): Patients were randomized to gonadotropin drugs with varyin g doses of LH per ampule: recombinant FSH containing no LH (group 0, n = 39 ), urinary FSH containing <1 IU of LH per ampule (group 1, n = 30), hMG con taining 25 IU of LH per ampule (group 25, n = 30), and hMG containing 75 IU of LH per ampule (group 75, n = 29). The FSH dose was kept constant at 75 IU per ampule. A long-protocol GnRH-analog regimen was used. Main Outcome Measure(s): Dose and duration of gonadotropin stimulation, fol licle and oocyte numbers, implantation rate, and pregnancy rate. Result(s): The median duration of ovarian stimulation; median number of gon adotropin ampules used; serum E-2 levels: and numbers of follicles, oocytes , and embryos were similar among the four groups. Median LH levels on the d ay of hCG administration, however, differed significantly. Live birth rates per cycle differed markedly, but statistical significance was not achieved (23%, 7%, 20%, and 31% for groups 0, 1, 25, and 75, respectively). A signi ficant trend in implantation rates was noted with increasing LH dosage of t he urinary preparations (19%, 10%, 18%, and 28% for groups 0, 1, 25, and 75 , respectively). Conclusion(s): In the present study, although the residual endogenous LH af ter down-regulation was adequate for ovarian response and E-2 synthesis, th e addition of exogenous LH improved implantation. An FSH/LH ratio of 75/75 IU per ampule appeared to be the optimum dose. (Fertil Steril((R)) 2001;75: 324-31. (C) 2001 by American Society for Reproductive Medicine.).