Application Of Recombinant Human Luteinizing Hormone In Ovulation Stimulation Of Assisted Reproductive Technique

【Background]】According to the two-cell, two-gonadotrophin theory, both FSH and LH are important for folliculogenesis in humans. FSH acts throughout the gonadotrophin-regulated phase of follicular development by inducing aromatase activity, and expression of LH receptors in granulosa cells. Each follicle has a threshold beyond which it must be stimulated by FSH to initiate pre-ovulatory development, it may also have a'ceiling'within which it should be stimulated by LH, above which normal development is terminated. Some doctors thought that the profound suppression of endogenous LH by gonadotrophin-releasing hormone agonist (GnRH-a) in long protocol maight effect the rates of oocytes retrieved and 2PN. While some people thought that residual circulating levels of endogenous LH were usually adequate to support multiple follicular growth and oocyte development. Our paper is written with the aim to explore the influence on the clinical outcomes of using recombinant human luteinizing hormone(r-hLH) in IVF/ICSI-ET.【Objective】To evaluate application of r-hLH used in ovarian stimulation of assisted reproductive technique and impact on outcome of pregnancy.【Methods】From Apr.2009 to Jul.2009,123 patients with low LH level (<1 IU/L) at day 3 of menstruation and down-regulation of pituitary function undergoing IVF-ET in Reproductive Medical Center, Provincial Hospital Affiliated to Shandong University were enrolled in this study, whom were classified into 66 cases treated by r-hLH in r-hLH group and 57 cases without r-hLH treatment in non-r-hLH group. In the mean time,145 patients with normal level of serum LH (1～2 IU/L) not given by r-hLH treatment and undergoing IVF-ET were matched as control group. Total amount of gonadotropin, estradiol levels and LH levels on the administration of hCG, number of oocytes retrieved, number of 2PN zygotes, rate of high quality embryos, the rates of implantation and clinical pregnancy were compared among these three groups.[Results] The level of serum LH on the day of hCG administration were (1.59±0.77) IU/L in r-hLH group, (0.54±0.25)IU/L in non-r-hLH group and (2.39±1.01) IU/L in control group, which reached statistical difference between every two groups(P<0.05). The rates of high quality embryo were 59.36% in r-hLH group, 57.79% in non-r-hLH group, which were significantly lower than 65.94% in control group, respectively (P<0.05). The rates of 2PN were 67.62% in r-hLH group and 68.32% in control group, which were significantly higher than 62.84% in non-r-hLH group, respectively (P<0.05). The rates of implantation of 29.77% in r-hLH group were significantly higher than 18.26% in non-r-hLH group (P<0.05). The total amount of Gn, E2 level on the day of hCG administration, the number of oocytes retrieved, and clinical pregnancy rate were not significantly different among those three groups (P>0.05).[Conclusion] The administration of recombinant human luteinizing hormone in patients who were profoundly suppressed after down-regulation with long protocol could get more quality embryos, the higher rates of 2PN and implantation.