Does optimizing treatment protocols from the start prevent hypo-response in ART cycles?

The speaker's recommendation is direct: there is no reason not to start with recombinant FSH combined with LH from the beginning, especially in groups at risk of hypo-response. The logic is not to "rescue" a cycle by adding LH midway, once time is already lost, but to build in adequate support from the outset.

This shifts hypo-response prevention to the planning stage. Instead of reactive correction — proactive choice of drug and dose to fit the patient's phenotype. This is especially true for older patients and those with presumed reduced receptor sensitivity.

The lecture's quote sums up the message: "Up to half of our patients give up as early as the first or second trial — one more reason to get it right from the start." Patient retention here appears not as an organisational metric but as a clinical one.

This view naturally connects to the concept of cumulative live birth: a programme's success is measured not by a single transfer but by the chance of a baby per started treatment cycle. If the first cycle loses the patient, the cumulative figure resets to zero — no matter how good the second or third protocol might have been.

Hence the practical emphasis on identifying patients at risk of hypo-response before the first cycle — by age, ovarian reserve, history and, where available, receptor profile. It is in them that a "correct start" with LH support yields the greatest gain, while the "standard" protocol most often ends in a suboptimal result.

For the clinician the takeaway is practical: treat the first cycle as decisive, judge not only the outcome of a single transfer but the cumulative result and the likelihood of continued treatment, and do not postpone LH support if it is indicated already at the start.