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Human Menopausal Gonadotropin Supplied Luteinizing Hormone Activity - Helpful, Harmful or Necessary?
Richard P. Marrs, MD

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I’m Dr. Richard Marrs. I spoke on the issues of LH activity in controlled ovarian hyper stimulation cycles. The main message in the discussion was concerning whether LH was necessary for ovarian stimulation in the ART patient, and if it is necessary, how much and when should it be added into the stimulation protocol? In reviewing the literature, the issues are fairly clear that LH activity is helpful. It is more helpful in cycles where profound LH suppression has occurred, either from gonadotropin releasing hormone agonist or antagonist, to induce a more normal estradiol curve after follicle growth, before maturity. 

The actual amount of LH is still undetermined and the source of LH can be variable; whether it is in the actual form of LH activity and hMG products, or even LH activity as induced by hCG, which is found in hMG products or can be used alone. The amount, or ceiling, or maximum amount of LH that is understood is not known yet. We don’t actually know what the ceiling really is for LH activity during stimulation; that remains to be determined by future studies.

Suffice it to say, the bottom line is that in stimulation protocols in most patients, the use of hMG, or hMG induced LH activity, is certainly not harmful for stimulation protocols. And in certain clinical situations it will improve not only the outcome of the stimulation protocol, but in turn will improve implantation in ongoing pregnancy rates.