LH Supplementation in Ovarian Stimulation for IVF: The Individual, LH Deficient, Patient Perspective.

The availability of recombinant follicle-stimulating hormone (FSH) and luteinizing hormone (LH) opens an opportunity to individualize ovarian stimulation. While the need for FSH in ovarian stimulation is universal, a question remains whether exogenous LH is beneficial. Previous population-based research showed that added LH is indicated in elderly and in profoundly LH depressed patients. This commentary explores potential individual patient parameters that may hint that this specific individual may prospectively need supplemented LH, irrespective of her age or experience from previous cycles. Specifically, it is suggested that in an antagonist protocol, the degree of LH recovery 24 h post first GnRH antagonist injection can identify those patients who may benefit from added LH. In addition, rising LH during the first 5 days of stimulation may predispose patients to a sharp LH drop following the first GnRH antagonist dose, and the need for added LH.