Recombinant LH supplementation to recombinant FSH during induced ovarian stimulation in the GnRH-antagonist protocol: a

Ricardo Baruffi obtained his MD degree in 1985 in the Federal University of Uberlândia and the specialist degree in Gynaecology and Obstetrics in 1988 at Sao Paulo University in the Ribeirao Preto Medical School. During the last 17 years he has been working as a specialist in reproductive endocrinology at the Center for Human Reproduction Prof Franco Jr, Ribeirao Preto, SP, Brazil. He is also, together with Professor Franco Jr, one of the founders of the Assisted Reproduction Brazilian Society. Dr Baruffi is the author of numerous papers and abstracts. He had the pleasure to witness the revolution of ovarian stimulation in assisted reproduction. Abstract This study aims to compare the efficacy of recombinant LH (r-LH) supplementation for ovarian stimulation in gonadotrophin- releasing hormone-antagonist protocol for IVF/intracytoplasmic sperm injection cycles. Search strategies included online surveys of databases. The fixed effects model was used for odds ratio (OR) and effect size (weighted mean difference, WMD). Five trials fulfilled the inclusion criteria. When the meta-analysis was carried out, advantages were observed for the LH supplementation protocol with respect to higher serum oestradiol concentrations on the day of human chorionic gonadotrophin administration (P < 0.0001; WMD: 514, 95% CI 368, 660) and higher number of mature oocytes (P = 0.0098; WMD: 0.88, 95% CI 0.21, 1.54). However, these differences were not observed in the total amount of recombinant FSH (r-FSH) administered, days of stimulation, number of oocytes retrieved, the clinical pregnancy rate per oocyte retrieval, the implantation rate and miscarriage rate. This result demonstrates that the association of r-LH with r-FSH may prevent any decrease in oestradiol after antagonist administration and that a significantly higher number of mature oocytes was available for laboratory work. Nevertheless, it failed to show any statistically significant difference in clinically significant end-points in IVF (implantation and pregnancy rates). Additional randomized controlled trials are needed to confirm these results further.