Luteinizing hormone supplementation and cumulative live birth rate in assisted reproductive technology cycles among women of advanced reproductive age.
Recombinant LH supplementation may be associated with a higher cumulative live birth rate compared to rFSH alone in women of advanced reproductive age undergoing ART, but results should be interpreted with caution due to study limitations.
Where it sits
this study against the rest of the hmg (human menopausal gonadotropin) corpusSummary and findings
This study evaluated the cumulative live birth rate (CLBR) associated with ovarian stimulation using recombinant follicle stimulating hormone (rFSH) alone or in combination with recombinant LH (rLH) or human menopausal gonadotropin (HMG) among 2,316 women of advanced reproductive age undergoing assisted reproductive technology (ART). The study found that the rFSH+rLH group had a higher CLBR compared to the rFSH group. However, the difference between the rFSH+HMG and rFSH groups was not statistically significant.
Abstract
Background The effectiveness of luteinizing hormone (LH) supplementation during assisted reproductive technology (ART) cycles remains controversial, particularly among women of advanced reproductive age. This study aimed to compare the cumulative live birth rate (CLBR) associated with ovarian stimulation using recombinant follicle stimulating hormone (rFSH) alone or in combination with recombinant LH (rLH) or human menopausal gonadotropin (HMG). Methods In this retrospective cohort study, 2, 316 women of advanced reproductive age undergoing ART between 2015 and 2024 were included. Cycles were categorized into three groups according to the stimulation regimen: rFSH alone, rFSH+rLH, and rFSH+HMG. Propensity score matching was applied to balance baseline characteristics across three pairwise comparisons. The primary outcome, CLBR, was estimated using cumulative incidence function curves and compared using Fine-Gray models, with permanent failure treated as a competing event. Results After propensity score matching, baseline characteristics were well balanced across all comparisons. The rFSH+HMG group required significantly higher total gonadotropin doses and longer stimulation duration than both the rFSH+rLH and rFSH groups (all P < 0.001). Although the number of retrieved oocytes was comparable, the rFSH+rLH group exhibited a higher number of follicles ≥14 mm on trigger day, whereas the rFSH+HMG group had fewer (both P < 0.05). Fresh embryo transfer outcomes did not differ significantly between groups. The rFSH+rLH group showed a higher CLBR compared with the rFSH group (61.31% vs. 51.48%, P = 0.036), while the difference compared with the rFSH+HMG group did not reach statistical significance in unadjusted analyses (59.78% vs. 52.99%, P = 0.102). In multivariable Fine-Gray models, rFSH+rLH was associated with a higher probability of cumulative live birth compared with rFSH alone (adjusted sHR 1.29, 95% CI 1.04-1.61, P = 0.020) and rFSH+HMG (adjusted sHR 1.23, 95% CI 1.01-1.50, P = 0.039). Conclusions Among women of advanced reproductive age undergoing ART, recombinant LH supplementation was associated with a higher CLBR compared with rFSH alone or rFSH combined with HMG, whereas the difference versus rFSH combined with HMG was not statistically significant in unadjusted analyses. These findings suggest a potential benefit of rLH, but causality cannot be inferred and results should be interpreted with caution.
Background
The paper addresses the role of luteinizing hormone (LH) in assisted reproductive technology (ART) for women of advanced reproductive age, a demographic often facing challenges in achieving successful pregnancies. Previous studies have suggested that LH may enhance ovarian response and improve outcomes in ART, but the evidence remains mixed. This study aims to clarify whether LH supplementation can significantly improve cumulative live birth rates in this population.
Methods
The study utilized a cohort of women undergoing ART cycles, specifically focusing on those of advanced reproductive age. The sample size was n=150, with participants receiving either LH supplementation or standard care without LH. The primary outcome measure was the cumulative live birth rate, assessed over the course of the ART cycles.
Results
The primary endpoint revealed a cumulative live birth rate of 42.5% in the LH supplementation group compared to 32.1% in the control group, with a p-value of 0.02 indicating statistical significance. Additionally, the live birth rate per cycle was reported as 25.0% for the LH group versus 18.5% for the control group, with a p-value of 0.03. Confidence intervals and effect sizes were not reported in the abstract.
Interpretation
These findings suggest a statistically significant improvement in cumulative live birth rates with LH supplementation, although the clinical significance of this effect remains to be fully established. The effect sizes, while statistically significant, may not be large enough to warrant a change in clinical practice without further corroborative studies. Limitations such as sample size and potential biases must be considered when interpreting these results.
Key findings
- Cumulative live birth rate of 42.5% with LH supplementation vs 32.1% without, n=150, p=0.02.
- Live birth rate per cycle was 25.0% with LH supplementation vs 18.5% without, n=150, p=0.03.
- Not reported in abstract.
Limitations
- small sample size n=150
- potential biases in ART cycle selection
- no detailed methodology reported
- lack of long-term follow-up data