Monday, February 25, 2019

LH as the villain in IVF protocols.

The purpose of an IVF superovulation protocol is to help you grow lots of follicles, which is why we use gonadotropin injections which contain 2 hormones - FSH and LH.
One of the problems is that the LH hormone can sometimes play the role of a rogue.
If there is an early LH surge, the follicles can rupture too early , and we may not be able to pick up an egg at all.
This used to be a major problem in the past, which has now been solved by using either GnRH agonists, or  GnRH antagonists, which prevent these LH surges.
Sometimes the LH surge may not be enough to cause premature follicular rupture, which means we can still collect eggs. However, a minor LH surge can cause premature luteinization , and as a result of the high progesterone levels this causes on the day of egg collection, the endometrial receptivity may be compromised.
This is why many clinics are now freezing all the embryos, so we do not transfer embryos in the fresh cycle at all. We can then transfer the frozen embryos in a follow up cycle , where we can prepared the endometrium for optimal receptivity using exogenous hormones such as estradiol.

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