Ovarian response and pregnancy outcome in poorresponder women:: a randomized controlled trial on the effect of luteinizing hormone supplementation on in vitro fertilization cycles

Objective: To prospectively assess the effect of using a combination of recombinant follicle-stimulating hormone (rFSH) and recombinant luteinizing hormone (rLH) on ovarian stimulation parameters and treatment outcome among poor-responder patients. Design: Prospective randomized trial. Setting: University-associated private medical center. Patient(s): Eighty-four patients who had a basal FSH level of >= 10 mIU/mL, who were >= 40 years of age, and who were undergoing their first IVF cycle participated in this controlled trial. Intervention(s): Patients were randomly allocated into two study groups: group A, in which ovarian stimulation included GnRH analogue and rFSH and rLH, and group B, in which patients received GnRH analogue and rFSH without further LH addition. Main Outcome Measure(s): Primary outcome measures included the ongoing pregnancy rate per retrieval and implantation rate per embryo transferred. The number of days of gonadotropin treatment, E-2 level on rHCG administration day, number of developed follicles, number of retrieved oocytes, number of normally fertilized zygotes (at the two-pronuclear [2PN] stage), cumulative embryo score, and number of transferred embryos were also evaluated. Result(s): The overall pregnancy rate was 22.61% (19 pregnancies among 84 couples). The pregnancy wastage rate was 30.00% in group A and 22.22% in group B. There were no differences in either primary or secondary end points. Conclusion(s): The results of this prospective and randomized trial show that the addition of rLH at a given time of follicular development produces no further benefit in the patient population of our study. A reduced ovarian response cannot be overcome by changes in the stimulation protocol.