LH deficiency during COS

Fischer builds the rationale for adding LH around a 2017 meta-analysis that pooled data on the combined use of FSH and recombinant LH. Without citing individual numerical results, he lays out the logic of the evidence: in defined subgroups, restoring LH is associated with a more favorable cycle course and helps correct an inadequate response.

He also examines the choice of endpoint used to judge the benefit of the intervention. The number of retrieved oocytes is treated as a practical and reproducible marker of the stimulation outcome, although the author stresses the need to weigh it against oocyte maturity, embryo quality and, ultimately, the pregnancy rate.

The practical section addresses the clinical scenarios in which adding recombinant LH is most justified: hypogonadotropic states, patients of advanced reproductive age, an unexpectedly weak response in a previous cycle, and signs of slow follicular growth on monitoring. Fischer offers reference points for the decision rather than a rigid universal algorithm.

The take-home message for the clinic is that assessing LH status should become part of protocol planning rather than a belated reaction to failure. Timely identification of patients with relative LH deficiency and personalized addition of recombinant LH help improve cycle efficiency in those for whom standard FSH monotherapy does not deliver a sufficient result. In this way, adding LH becomes a deliberate clinical decision matched to the individual patient's phenotype rather than a routine step.