A classification of clinical scenarios into three buckets: patients where LH is non-negotiable, patients where it almost is, and patients where the cycle can be run without it. Built on the two-cell two-gonadotrophin model, with examples spanning hypogonadotrophic hypogonadism, LHCGR polymorphism carriers, advanced reproductive age and prior protocol failure.
Bucket 1 (LH essential): hypogonadotrophic hypogonadism, Kallmann syndrome, post-pituitary surgery — without LH there is no steroidogenesis and no follicular maturation. Bucket 2 (LH almost essential): advanced reproductive age with low LH:FSH ratio, specific LHCGR polymorphisms, prior cycles with low oocyte maturity. Bucket 3 (LH optional): young patients with intact axis, first cycle, no prior failure. LH activity and HCG are not biologically equivalent.
Use the three-bucket map to decide on LH supplementation before the first stimulation cycle. Reserve recombinant LH for buckets 1 and 2; pure FSH protocol can be the first-line for bucket 3. Re-classify after the first cycle based on maturity, fertilisation and embryo development.
Bucket boundaries are not absolute — patient phenotype and prior cycle data shift the classification. LH supplementation has cost; reserve it for cases where physiology predicts a measurable difference. HMG, recombinant LH and HCG cover different parts of LH activity and are not interchangeable.
LH-receptor polymorphisms create a 'hidden' form of deficiency: the gonadotropin is normal on lab tests, but the receptor responds poorly. Clinically this looks like an inexplicably poor response or low estradiol despite an adequate FSH dose — a reason to suspect a receptor cause.
The two-cell, two-gonadotropin model explains why LH is irreplaceable: FSH drives granulosa aromatase, but its substrate is provided only by LH-dependent androgen synthesis in the theca. This link cannot be broken — estrogenesis requires both gonadotropins.
Recombinant LH and hCG have different kinetics: LH acts briefly and physiologically, hCG longer and more potently owing to prolonged receptor binding. The choice between them is determined by the task — fine support of steroidogenesis or a strong final stimulus.
The conclusion is a decision tree for prescribing recombinant LH: hypogonadotropic hypogonadism, age 35+, relative LH deficiency, a poor previous response, suspicion of receptor pathology. In these scenarios LH moves from a 'desirable' to a 'necessary' component of the protocol.
Three buckets of patients: those where LH is non-negotiable, those where it almost is, and those where you can manage without. The talk classifies clinical scenarios — hypogonadotrophic hypogonadism, LH receptor polymorphisms, advanced reproductive age — and gives a decision tree for when recombinant LH actually changes the cycle outcome.
Patients arrive at the clinic already having consulted ChatGPT, and regulators are reviewing the first AI ‘doctors’. What in artificial intelligence already works in reproductive medicine — from assistant avatars to embryo assessment and stimulation personalisation? A live discussion on three levels — strategy, service and clinic — with practical cases and a panel Q&A.
A Sona-Pharm grant award for specialists in infertility treatment. Applications open on 1 February 2027. Ceremony — July 2027, Stockholm, during the ESHRE meeting.
Targeted, biomarker-guided immunotropic therapy in reproductive medicine. A lecture by Kseniia Khazhylenko at the UARM Symposium 2026.
Audio: UASubtitles: UA32 min
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