Comparative Effects of Human Chorionic Gonadotropin and Recombinant Luteinizing Hormone Supplementation during the Late Follicular Phase

Author(s): Le Duc Thang, MD, Hoang Bao Long, MD, MPH, Tham Chi Dung, MD, PhD, Vu Thi Mai Anh, MD, Nguyen Thi Thuy Linh, MD, Nguyen Phuc Hieu, MD, Giap Thi Mai Phuong, B.Sc, Nguyen Thi Lien Huong,MD, PhD, Le Hoang, MD, PhD, Assoc. Prof, and Jean-Noël Hugues, MD, PhD, Prof.

Background:

In selected patients, addition of LH activity can improve the outcome of ovarian stimulation. Two common LH activity supplementation strategies are recombinant human LH (rLH) and human chorionic gonadotropin (hCG). The respective effectiveness of hCG versus rLH using various daily dosages and modes of administration is still discussed. In this study, we compared the outcomes of hCG versus rLH supplementation among patients with slow response to recombinant follicle stimulating hormone (rFSH).

Methods:

A retrospective study was conducted among infertile women with slow response to rFSH, who were given either rLH or hCG on day 6 of ovarian stimulation. The treatment effect of hCG versus rLH was adjusted using propensity score matching.

Results:

The study included 772 patients, of which 275 received rLH and 497 received hCG. In the unadjusted analysis, the number of oocytes retrieved, MII oocytes, cleavage embryos, and blastocyst embryos were higher in the hCG group than in the rLH group (mean ratios: 1.38 (95% CI 1.25, 1.52), 1.47 (95%CI 1.31, 1.65), 1.41 (95%CI 1.25, 1.58), 1.41 (95%CI 1.23, 1.61), respectively). In the adjusted analysis, the mean differences decreased to 1.19 (95%CI 1.01, 1.40), 1.23 (95%CI 1.00, 1.52), 1.14 (95%CI 0.94, 1.38), and 1.22 (95%CI 0.98, 1.53), respectively. Among the 121 patients in the rLH group and 302 in the hCG group who underwent embryo transfer, no significant differences could be demonstrated in endometrial preparation, endometrial thickness, number or type of embryos, or pregnancy outcomes.

Conclusions:

In infertile women displaying a slow response to rFSH, hCG supplementation was associated with a modest improvement in oocyterelated outcomes but comparable effects in terms of embryo-related and pregnancy outcomes as compared to rLH. hCG could be a potential alternative to rLH when addition of LH activity is required.