PowerPoint Presentation
RATIONALE FOR USE OF LH FOR OVULATION INDUCTION AND SUPER OVULATION
Luteinizing hormone (LH) induces ovulation and plays a vital role in conception and maintenanceof pregnancy. The hormone is secreted by the pituitary with peak levels during the mid-follicularphase of the menstrual cycle. Although follicular growth is initiated by follicle stimulating hormone(FSH), LH plays a crucial role in follicular maturation and preparation of the uterus for implantation.1
Carrying feelings of love and affectionKrishna IVF Clinic
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This cocnept is under goiung with the discovery of receptors and onset of genmic3
Role of lhmid follicular phase
LH the master regulator
Erk1 and Erk2 mediate the luteinizing hormone
The ovulatory response in mammals repre-sents a complex series of events consisting of at least four distinct components: the resumption of meiosis (also known as oocyte maturation), the expansion and mucification of the cumulus oophorus, a shift from the production of follicu-lar estrogen to the production of progesterone (with luteinization of the granulosa cells), and the disintegration of the follicle wall, which al-lows the release of the oocyte (Fig. 1). It has previously been shown that Erk1 and Erk2 medi-ate the effect of luteinizing hormone on both cumulus expansion and oocyte maturation (as es-tablished in vitro, with the use of cumulus-oocyte cultures and isolated intact ovarian follicles2,3). Moreover, a study of primary granulosa cell cul-ture suggests that Erk1 and Erk2 mediate the luteinizing hormoneinduced breakdown of cell-to-cell communication, a prerequisite of oocyte maturation (Fig. 1).3However, through their re-cent study, Fan et al. have found that Erk1 and Erk2 are essential to the entire repertoire of ovar-ian responses that result in ovulation
Master Regulators of Female Fertility. Available from: https://www.researchgate.net/publication/26736730_Master_Regulators_of_Female_Fertility [accessed Dec 11, 2016].5
Mile stones in development of gonadotropin
18 yrs.
The continuing quest for quality and consistency. Between 1930 and 1972, gonadotrophins from animal pituitaries and pregnant mare serum were used; due to allergic reactions and lack of efficacy, they were abandoned. Between 1958 and 1988, gonadotrophins from the pituitaries of human cadavers were used; they were also abandoned, due to the threat of CreutzfeldJacob disease. In the early 1960s, the purity of hMG was 5%, the remaining 95% consisted of significant amounts of known and unknown contaminating proteins. By the mid-1960s, improved purification processes were implemented that led to uFSH containing less LH, but contaminated with 95% of unwanted proteins. Improved purification processes still only achieved a purity of 4090%. Between 1996 and 2003, precautionary principles were applied in a number of countries leading them to restrict or abandon the use of urinary gonadotrophins.
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SO MANY BENEFITS?
THEN WHY
SO MANY BENEFITS? THEN WHY
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SO MANY BENEFITS? THEN WHY
LH IS POTENT HORMONE
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SO MANY BENEFITS? THEN WHY
LH NEED IS DIFFERENT AT DIFFERENT DAYS
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SO MANY BENEFITS? THEN WHY
MEDICATION AS A SOURCE
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LH
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Therapeutic window
Fsh threshold
Follicular recruitment threshold concept
Lh threshold
Luteinizing hormone (LH) induces ovulation and plays a vital role in conception and maintenanceof pregnancy. The hormone is secreted by the pituitary with peak levels during the mid-follicularphase of the menstrual cycle. Although follicular growth is initiated by follicle stimulating hormone(FSH), LH plays a crucial role in follicular maturation and preparation of the uterus for implantation.
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Optimal level for follicular deveopmentLH THRESHOLD >.5 to 1 IU/l LH Ceiling >5 IU/l
Elevated LH levels negative art
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SUPPRESSED LH LEVELS NEGATIVE EFFECT
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20The LH Therapeutic Window ConceptFollicular growth impairedInadequate androgen (and estrogen) synthesisNo full oocyte maturationLH thresholdNormal follicular growth and developmentNormal androgen and estrogen biosynthesisNormal oocyte maturation
Balasch J, Fbreques F. Curr Opin Obstet Gynecol 2002, 14:265-274Suppression of granulosa cell proliferationFollicular atresia (nondominant follicles)Premature luteinization (preovulatory follicle)Oocyte development compromisedLH ceiling
Luveris AC PresentationSerono, Inc.20Therapeutic window is best observed severe endogenous lh deficiency hypogonadotrophin hypogonadismThe second group involves severe lh suppression in long protocol
This is where we should be
Therapeutic window
Who needs LH ?
ASIA PACIFIC LH ADBOARD.
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Review
Beneficial effect of LH supplementation in ART
Not every woman needs lh supplementation and as most of the women will respond with extremely low levels of lh .Infact only 1 % receptor occupation will be suffice Day 6 lh level 0.5 miu/mlThese pt had more oocyte ,6.3 to 7.3 ,higher fertilization rate 92% versus 69%pregnancy rate and implanatation rate and on going pregnancy rate 22% and 5 %
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Women > 35 years:
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Poor responder
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Poor responder
HYPORESPONDER
POOR RESPONDER HAVE LOWER PROGNOSIS
HYPO RESPONDER HAVE GOOD PROGNOSIS
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Hypo responder
LH IN HYPORESPONDER
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Hypo responder correction with LH Poseidon Group f&S 2016
How to identify them
On going poor responder add lh
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LH polymorphism A few words
37LH and FSH Action on the Follicle
Theca externa cellsTheca interna cellsCapillary networkBasement membraneCumulusOophoruscellsOocyteZona pellucidaGranulosacellsFollicularantrum
LH receptorson theca cells
FSH receptors on granulosa cells
E2FSH
LH
A
Luveris AC Presentation, Inc.37
LH polymorphism 1500 patients 2012 -2016
LH polymorphism
LH polymorphism These are known cause for hypo response
Summary :
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Summary
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