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 treatment groups. Setting: Human Assisted Reproduction Unit, Rotunda Hospital, Dublin, Ireland. Patient(s): Infertile normogonadotropic women undergoing their first cycle of IVF were studied. Intervention(s): Patients were randomized to gonadotropin drugs with varying 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 containing 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, follicle and oocyte numbers, implantation rate, and pregnancy rate. Result(s): The median duration of ovarian stimulation; median number of gonadotropin ampules used; serum E 2 levels; and numbers of follicles, oocytes, and embryos were similar among the four groups. Median LH levels on the day 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 significant trend in implantation rates was noted with increasing LH dosage of the 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 after down-regulation was adequate for ovarian response and E 2 synthesis, the addition of exogenous LH improved implantation. An FSH/LH ratio of 75/75 IU per ampule appeared to be the optimum dose.