Exogenous luteinizing hormone (LH) increases estradiol response patterns in poor responders with low serum LH concentrations

Purpose: Our purpose was to investigate whether the addition of exogenous leuteinizing hormone (LH) increases estradiol secretion in LH- depleted women undergoing controlled ovarian hyperstimulation (COH) with purified follicle stimulating hormone (FSH). Methods: We carried out case series and retrospective analysis of midfollicular serum LH concentrations and estradiol response patterns in COH cycles. All patients initially received gonadotropins containing purified FSH. Human menopausal gonadotropin containing LH was added to poor responders with low midfollicular LH concentrations. Results: The addition of exogenous LH to the COH regimen significantly increased estradiol secretion in poor responders with low midfollicular endogenous LH concentrations. This was confirmed statistically by an average change in the slope of the estradiol patterns from 27.54 to 85.49 after the addition of exogenous LH. Furthermore, patients with midfollicular serum LH concentrations <3.0 mlU/ml had significantly lower midfollicular and peak estradiol (E₂) concentrations compared to patients with LH concentrations ≥3.0 mlU/ml (352.3 and 2094.3 vs 855.6 and 3757.1 pg/ml, respectively). Conclusions: The addition of exogenous LH increases E₂ response patterns in poor responders with low midfollicular serum LH concentrations. Low midfollicular serum LH concentrations are associated with significantly lower midfollicular and peak E₂ concentrations.