The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis

Objective To evaluate the effect of recombinant LH in assisted reproduction technology (ART) cycles in patients of advanced reproductive age. Design A systematic review and meta-analysis. Setting Published randomized controlled clinical trials comparing recombinant LH plus recombinant FSH versus recombinant FSH only in patients of advanced reproductive age. Patient(s) Patients 35 years and older undergoing assisted reproduction. Intervention(s) Recombinant LH plus recombinant FSH controlled ovarian hyperstimulation (COH) versus recombinant FSH stimulation only in assisted reproduction cycles. Main Outcome Measure(s) Implantation and clinical pregnancy. Result(s) Seven trials were identified that met inclusion criteria and comprised 902 assisted reproduction technology cycles. No differences in serum E2 on the day of hCG administration were reported in any trials. Two trials reported lower oocyte yield and one trial reported lower metaphase II oocyte yield in the recombinant LH-supplemented group. One trial reported higher fertilization rates in the recombinant LH-supplemented group. In a fixed effect model, implantation was higher in the recombinant LH-supplemented group (odds ratio 1.36, 95% confidence interval 1.05–1.78). Similarly, clinical pregnancy was increased in the recombinant LH-supplemented group (odds ratio 1.37, 95% confidence interval 1.03–1.83). Conclusion(s) The addition of recombinant LH to ART cycles may improve implantation and clinical pregnancy in patients of advanced reproductive age.