Lh hormone 2017
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RATIONALE USE OF LH IN IVF
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Lh hormone 2017
- 1. RATIONALE FOR USE OF LH FOR OVULATION INDUCTION AND SUPER OVULATION
- 2. Carrying feelings of love and affection Krishna IVF Clinic
- 3. Ryan and colleagues 1960 Two cell two gonadotrophin Fsh granulosa cell Lh on theca cell
- 4. Role of lh • mid follicular phase
- 5. LH the master regulator Erk1 and Erk2 mediate the luteinizing hormone
- 6. Mile stones in development of gonadotropin 18 yrs.
- 7. SO MANY BENEFITS? THEN WHY
- 8. SO MANY BENEFITS? THEN WHY 1 BASIC PHYSIOLOGY 2 DIFFERENT PROTOCOLS 3 DIFFERENT DRUGS 4 therapeutic window
- 9. SO MANY BENEFITS? THEN WHY POTENT HORMONE 1% BOUND AFTER GNRH 1 IU/L •LH IS POTENT HORMONE
- 10. SO MANY BENEFITS? THEN WHY NATURAL CYCLE ANTAGONAGONIST •LH NEED IS DIFFERENT AT DIFFERENT DAYS
- 11. SO MANY BENEFITS? THEN WHY rec LH HMG rec FSH •MEDICATION AS A SOURCE
- 12. LH INCREASED FERTILIZATION ESTRADIOL LEVELS LOW LEVEL OF APOPTOSIS
- 14. Fsh threshold
- 15. Follicular recruitment threshold concept •
- 16. Lh threshold
- 17. Optimal level for follicular deveopment LH THRESHOLD >.5 to 1 IU/l LH Ceiling >5 IU/l
- 18. 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
- 19. 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.
- 20. 2 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
- 21. This is where we should be Therapeutic window
- 22. Who needs LH ?
- 23. ASIA PACIFIC LH ADBOARD.
- 24. Review
- 25. 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
- 26. Women > 35 years: 26 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 the number of mature eggs collected, improved implantation and pregnancy rates •Marrs et al, 2003; Humaidan et al, 2004
- 27. Poor responder Previous poor response less number of egg AMH AFC
- 28. Poor responder
- 29. HYPORESPONDER
- 30. POOR RESPONDER HAVE LOWER PROGNOSIS HYPO RESPONDER HAVE GOOD PROGNOSIS
- 31. Hypo responder
- 33. Hypo responder correction with LH Poseidon Group f&S 2016
- 34. How to identify them
- 35. 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
- 36. LH polymorphism A few words
- 37. 37 LH and FSH Action on the Follicle Theca externa cells Theca interna cells Capillary network Basement membrane Cumulus Oophorus cells Oocyte Zona pellucida Granulosa cells Follicular antrum LH receptors on theca cells FSH receptors on granulosa cells E2 FSH LH A
- 38. LH polymorphism 1500 patients 2012 -2016 312 position •wild •Heterozygous •homozygous 6 base pair insertion •heterozygous •homozygous
- 39. Studied 1500 couple over a period of 4 years Found the following polymorphism relevant in INDIA Fshr 29 fshr 307 FSHR 680
- 40. Studied 1500 couple over a period of 4 years Found the following polymorphism relevant in INDIA LHCGR 680 LHCGR 6 base insertion
- 41. LH polymorphism 312 position •wild •Heterozygous •homozygous Need LH supplementation •heterozygous •homozygous
- 43. LH polymorphism These are known cause for hypo response
- 44. Summary : Expected poor responder •Hyp-oresponder •age >35 (agonist and antagonist) •GENETIC MUTATAION LOW LH ACTIVITY IN THECA & GRANULO CELLL
- 45. 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
- 46. THANK YOU