Luteinizing hormone add-back is it needed in controlled ovarian stimulation, and if so, when?

OBJECTIVE: To present an evidence-based rationale for or against the use of supplemental luteinizing hormone (LH) versus follicle-stimulating hormone (FSH) alone in various controlled ovarian stimulation (COS) protocols and specific patient populations. Any evidence for or against an association between endogenous LH levels and the likelihood of pregnancy in in vitro fertilization (IVF) procedures will also be presented. STUDY DESIGN: Literature review and critical analysis of evidence drawn from systematic reviews and meta analyses published in the last 3 years and from data subsequently reported (through mid-2009) by well controlled randomized trials. Evidence from observational and retrospective studies will be discussed if no higher level evidence is available on a particular topic. RESULTS: Low endogenous LH levels associated with long gonadotropin-releasing hormone (GnRH) agonist protocols do not appear to decrease the probability of a successful IVF outcome. Supplemental LH does not appear to be routinely indicated for patients undergoing COS in long GnRH agonist protocols, though the evidence seems to favor some form of LH add-back in certain well-defined subgroups treated with these protocols.CONCLUSION: Current evidence suggests that exogenous LH does not confer any significant benefit in women undergoing treatment with GnRH antagonist regimens, but more data are needed to confirm this finding.