Is luteinising hormone (LH)-bioactivity really necessary?

A debate about the importance and amount of LH-bioactivity necessary for optimal follicular stimulation¹

Abstract

Historically, follicular stimulation protocols have included both follicle-stimulating hormone (FSH) and LH in an attempt to mimic the physiology of normal human folliculogenesis. However, many recent gonadotrophin administration regimens have completely eliminated LH bioactivity. The importance and the amount of LH necessary for optimal follicular stimulation has been a topic of debate. Several recent studies have added to our understanding of the actions of androgens, oestrogens, gonadotrophins, and insulin on the follicle–oocyte unit, allowing a less speculative approach. Moreover, the availability of human gonadotrophins synthesised by recombinant DNA technology and gonadotrophin-releasing hormone (GnRH) antagonists, should soon permit a precise in vivo assessment and re-evaluation of the historical 2-cell, two-gonadotrophin hypothesis. These pharmacological tools may also provide essential insights into the physiological roles of FSH and LH in human follicular development and oocyte maturation. The recombinant gonadotrophins give clinicians the unique opportunity to tailor ovarian stimulation regimens according to the patient’s medical history, in an effort both to maximise oocyte yield and to improve oocyte quality.

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