Adding luteinizing hormone to follicle stimulating hormone from day 3-5 improves pregnancy outcome in normal but not poor responders using gonadotropin releasing hormone antagonists

Purpose: To determine if the addition of luteinizing hormone (LH) to follicle stimulating hormone (FSH) stimulation for controlled ovarian hyperstimulation (COH) protocols using gonadotropin releasing hormone (GnRH) antagonists improves pregnancy rates following in vitro fertilization-embryo transfer (IVF-ET). Materials and Methods: All IVF-ET cycles using a GnRH antagonist were evaluated according to whether FSH was used exclusively or if LH was added. The cycles were further stratified according to age (≤ 39 and 40-42 years) and according to good responders (≥ five oocytes retrieved) or poor responders (≤ four oocytes). Results: Combining all data, a significantly higher clinical and live delivered pregnancy rates were found in those adding LH (34.7% and 32.3%) vs those taking all FSH (33.4% and 25.8%). The only subgroup not showing this effect was the women aged 40-42 years with diminished oocyte reserve. Conclusions: LH should be added not only to COH protocols using GnRH agonists but also those using GnRH antagonists.