Background: The potential benefit of adding recombinant human luteinizing hormone (r-hLH) to recombinant\nhuman follicle-stimulating hormone (r-hFSH) during ovarian stimulation is a subject of debate, although there is\nevidence that it may benefit certain subpopulations, e.g. poor responders.\nMethods: A systematic review and a meta-analysis were performed. Three databases (MEDLINE, Embase and\nCENTRAL) were searched (from 1990 to 2011). Prospective, parallel-, comparative-group randomized controlled trials\n(RCTs) in women aged 18ââ?¬â??45 years undergoing in vitro fertilization, intracytoplasmic sperm injection or both,\ntreated with gonadotrophin-releasing hormone analogues and r-hFSH plus r-hLH or r-hFSH alone were included.\nThe co-primary endpoints were number of oocytes retrieved and clinical pregnancy rate. Analyses were conducted\nfor the overall population and for prospectively identified patient subgroups, including patients with poor ovarian\nresponse (POR).\nResults: In total, 40 RCTs (6443 patients) were included in the analysis. Data on the number of oocytes retrieved\nwere reported in 41 studies and imputed in two studies. Therefore, data were available from 43 studies (r-hFSH plus\nr-hLH, n = 3113; r-hFSH, n = 3228) in the intention-to-treat (ITT) population (all randomly allocated patients, including\nimputed data). Overall, no significant difference in the number of oocytes retrieved was found between the r-hFSH\nplus r-hLH and r-hFSH groups (weighted mean difference -0.03; 95% confidence interval [CI] -0.41 to 0.34). However,\nin poor responders, significantly more oocytes were retrieved with r-hFSH plus r-hLH versus r-hFSH alone (n =\n1077; weighted mean difference +0.75 oocytes; 95% CI 0.14ââ?¬â??1.36). Significantly higher clinical pregnancy rates were\nobserved with r-hFSH plus r-hLH versus r-hFSH alone in the overall population analysed in this review (risk ratio [RR]\n1.09; 95% CI 1.01ââ?¬â??1.18) and in poor responders (n = 1179; RR 1.30; 95% CI 1.01ââ?¬â??1.67; ITT population); the observed\ndifference was more pronounced in poor responders.
Loading....