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Is Luteinizing Hormone (LH) Add Back Protocol Right for You?
March 22, 2013
Despite being a controversial in vitro fertilization (IVF) therapy, data suggests that a Luteinizing Hormone (LH) add back protocol may be beneficial for embryo implantation and retrieving a higher number of eggs with lower doses of fertility drugs.
The theory supporting the LH add back protocol is that, typically, fertility patients endure hormone suppression to prevent any ovarian activity. This creates a “blank slate” for ovarian stimulation to begin and gives fertility doctors complete control over the IVF cycle. However, during the suppression phase, both FSH and LH are silenced. John Schnorr, M.D. of Coastal Fertility Specialists in Columbia, South Carolina, states: “When we do IVF, we artificially suppress the hormones so we get control over ovarian function. This way, [fertility patients] don’t ovulate on us in the middle of the night. We use Lupron to suppress hormones, but it takes away FSH (follicle stimulating hormone), which is the egg maker, and LH, which also contributes to egg making.” By shutting down the production of natural FSH and LH, there becomes a need to replace FSH in a higher dose in order to maximize the number of follicles producing eggs for retrieval.
One study, published in the journal Reproductive Biomedicine Online in 2011 showed that high doses of antagonist drugs like Ganirelix or Cetrotide were associated with lower embryo implantation rates. After administering 375IU of LH during the ovarian stimulation phase until hCG trigger shot, it was shown that implantation rates increased for the study group versus the control group that did not receive LH add back.
“The data is controversial but I the feel data leans toward LH as a positive. It might improve pregnancy rates. LH helps FSH work so we can get maybe ten eggs with less medication,” Schnorr says.
LH should be administered at the same time as FSH, during the follicle stimulation period when a fertility patient would be using injectable ovarian stimulation drugs. It can be prescribed as and LH drug like Luveris, as an FSH and LH combination drug like Menopur or Repronex, or in the form of hCG, which Dr. Schnorr explains is active on the LH receptor in the brain. “Seventy-five to eighty percent of all IVF cycles have some form of LH add back,” he states.
Though there is not specific data on which fertility patients are candidates for the LH add back protocol, Dr. Schnorr advises that all patients should also receive LH due to the fact that it is inexpensive and there is no downside to LH add back. Women who are not using Lupron in their IVF protocol do not need LH add back, while women with Hypothalamic Amenorrhea should definitely use LH add back. The LH add back protocol is recommended in conjunction with an IVF cycle, and is not necessarily needed for intrauterine insemination (IUI) cycles. This is likely because lower doses of FSH are prescribed and suppression drugs like Lupron are not used in an IUI cycle.
Fertility patients should discuss the benefits of an LH add back protocol with their fertility doctor, especially if they have suffered failed IVF cycles or are following an Antagonist IVF protocol.