To add or not to add LH: comments on a recent commentary

Area of Science:

• Reproductive Endocrinology
• Assisted Reproductive Technology (ART)

Background:

• Historically, Luteinizing Hormone (LH) activity supplementation in assisted reproductive technology (ART) stimulation protocols was debated.
• Current evidence supports LH activity's role in optimizing clinical outcomes for specific patient subgroups.
• Previous focus included hypogonadotropic hypogonadal patients, those over 35, and normogonadotropic patients with low recombinant FSH (rFSH) response.

Discussion:

• A newly identified subgroup includes normogonadotropic patients with high endogenous LH levels (>1.99 IU/l) on day 8 post-GnRH agonist downregulation.
• Supplementation with recombinant LH (rLH) from day 8 improved implantation rates in this subgroup, matching those with lower LH levels.
• Distinct endogenous LH level dynamics during downregulation were observed in patients with high LH levels.

Key Insights:

• Endogenous LH immunoreactivity may not correlate with bioactivity, potentially explaining rLH benefits in patients with high endogenous LH.
• LH supplementation appears crucial for specific patient profiles undergoing ART.
• Targeted subgroup analysis is essential for understanding LH's role in ART.

Outlook:

• Further research should investigate the precise mechanisms of LH bioactivity in ART.
• Subgroup-specific strategies for LH supplementation could refine ART protocols.
• Personalized ART approaches considering endogenous LH levels and dynamics are promising.