LH Priming Before Ovarian Stimulation in Poor Responders: Effects on Oocyte Recovery and Post ICSI/IVF Pregnancy Rates

Background: Androgen-mediated LH activity stimulates early follicle growth. LH pre- treatment appears to improve ovarian responses in ICSI/ IVF practice but has not yet been sufficiently assessed in poor responders.

Methods: POSEIDON-4 patients (maternal age≥35; AFC<5 and/or AMH <1.2ng/mL) were stimulated with FSH+LH in a flexible antagonist protocol (Control; n=129) or subjected to the same stimulatory treatment preceded by a seven-day LH priming (150 IU/day) under GnRHa downregulation (LH priming; n=106). Follicular responses and ICSI/IVF outcomes were compared between treatment-groups in overall patients and in a subgroup of 136 patients with severely decreased follicular availability (AMH<0.75ng/mL).

Results: Overall POSEIDON-4 patients in the “LH priming” group achieved a twice higher clinical pregnancy rate (p=0.02), accompanied by a 40% reduction in cycle cancellation (p=0.03) and increased production of viable embryos (p=0.02). A multivariate analysis indicated a robust association between “LH priming” and pregnancy achievement, independent of confounding variables (OR=2.58; p=0.02). A two-fold increase in clinical pregnancy rate was also observed in severely restricted POSEIDON-4 patients in the “LH priming” group (p=0.05), this time, accompanied by a higher oocyte yield (p≤0.04).

Conclusion: A pre-ovarian stimulation LH priming can markedly improve ICSI/IVF outcomes of POSEIDON-4 patients, benefiting in different ways subgroups of this challenging patient group.

Keywords: Luteinizing hormone; Ovarian stimulation; Oocyte; ICSI; IVF; Poor responders; Advanced maternal age