lh hormone 2017
TRANSCRIPT
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RATIONALE FOR USE OF LH FOR OVULATION INDUCTION AND SUPER OVULATION
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Carrying feelings of love and affection
Krishna IVF Clinic
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Ryan and colleagues 1960
Two cell two gonadotrophin
Fsh granulosa cell Lh on theca cell
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Role of lh• mid follicular phase
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LH the master regulator
Erk1 and Erk2 mediate the luteinizing hormone
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Mile stones in development of gonadotropin
18 yrs.
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SO MANY BENEFITS?
THEN WHY
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SO MANY BENEFITS? THEN WHY
1 BASIC PHYSIOLOGY
2 DIFFERENT PROTOCOLS
3 DIFFERENT DRUGS
4 therapeutic
window
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SO MANY BENEFITS? THEN WHY
POTENT HORMONE
1% BOUND
AFTER GNRH 1
IU/L
•LH IS POTENT HORMONE
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SO MANY BENEFITS? THEN WHY
NATURAL CYCLE
ANTAGONAGONIST
•LH NEED IS DIFFERENT AT DIFFERENT DAYS
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SO MANY BENEFITS? THEN WHY
rec LHHMG
rec FSH
•MEDICATION AS A SOURCE
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LH INCREASED
FERTILIZATION
ESTRADIOL LEVELS
LOW LEVEL OF
APOPTOSIS
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Therapeutic window
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Fsh threshold
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Follicular recruitment threshold concept •
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Lh threshold
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Optimal level for follicular deveopment
LH THRESHOLD >.5 to 1 IU/l
LH Ceiling >5 IU/l
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Elevated LH levels negative art
Regan et al 1990
Loumaye et al 2003
Stranger et al 1985
Watson et al 1993
Kolibanakis et al 2003
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SUPPRESSED LH LEVELS NEGATIVE EFFECT
Odea et al 2008
Lahound et al 2006
Flemming et al 1996
Westergarad et al 2000
Propst et al 2011.
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The LH Therapeutic Window Concept
• Follicular growth impaired• Inadequate androgen (and estrogen) synthesis• No full oocyte maturation
LH threshold
Normal follicular growth and development
Normal androgen and estrogen biosynthesis
Normal oocyte maturation
Balasch J, Fábreques F. Curr Opin Obstet Gynecol 2002, 14:265-274
• Suppression of granulosa cell proliferation• Follicular atresia (nondominant follicles)• Premature luteinization (preovulatory follicle)• Oocyte development compromised
LH ceiling
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This is where we should be
Therapeutic window
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Who needs LH ?
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ASIA PACIFIC LH ADBOARD.
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Review
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Beneficial effect of LH supplementation in ART
Age• Marrs et al;Humaidan
et al 2004
Initial poor responder
Follicular stagnation
• Ferrarettti et al; 2004
Low poor responders• Ruvolo et al. 2007
LH POLYMORPHISIM
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Women > 35 years:
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The number of functional LH receptors decreases with age•Vihko et al,1996
Endogenous LH may become less potent or biologically active•Mitchell et al, 1995
The only group to benefit from LH supplementation with an increase in thenumber of mature eggs collected, improved implantation and pregnancy rates•Marrs et al, 2003; Humaidan et al, 2004
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Poor responder
Previous poor response less number of egg
AMHAFC
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Poor responder
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HYPORESPONDER
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POOR RESPONDER HAVE LOWER PROGNOSIS
HYPO RESPONDER HAVE GOOD PROGNOSIS
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Hypo responder
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LH IN HYPORESPONDER
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Hypo responder correction with LH Poseidon Group f&S 2016
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How to identify them
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On going poor responder add lh• BMI• age • afc
with optimum dose
• AFC good• But not many coming up
lower rate of follicle growth
• day 6• day 8lower e2
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LH polymorphism A few words
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LH and FSH Action on the FollicleTheca externa cells
Theca interna cells
Capillary network Basement membrane
CumulusOophoruscells
OocyteZona pellucida
Granulosacells Follicular
antrum
LH receptorson theca cells
FSH receptors on granulosa cells
E2
FSH
LHA
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LH polymorphism 1500 patients 2012 -2016
312 position
• wild• Heterozygous• homozygous
6 base pair insertion
• heterozygous• homozygous
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Studied 1500 couple over a period of 4 years
Found the following polymorphism relevant in INDIA
Fshr 29
fshr 307
FSHR 680
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Studied 1500 couple over a period of 4 years
Found the following polymorphism relevant in INDIA
LHCGR 680
LHCGR 6 base insertion
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LH polymorphism
312 position
• wild• Heterozygous• homozygous
Need LH supplementation
• heterozygous• homozygous
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LH polymorphism These are known cause for hypo response
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Summary :
Expected poor responder •Hyp-oresponder
•age >35 (agonist and antagonist)•GENETIC MUTATAION
LOW LH ACTIVITY IN THECA &GRANULO CELLL
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Summary
Poor responder and hypo-responder are different
•You can improve pregnancy rates
•You identify in a current cycle
•You can analyze from previous cycle
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THANK YOU