Reproductive healthLecture
LH Deficiency in Patients of Advanced Reproductive Age: Pathogenesis and Treatment
An 18-oocyte cycle at 40 with a poor maturation rate is no longer surprising. Why advanced reproductive age is not only quantity but quality, what relative LH deficiency does to oocyte competence, and how to read the LH:FSH ratio when planning a stimulation in the over-38 patient.
Audio: UASubtitles: EN · UA · RU29 min
Myroslava Vatsyk
MD, PhD
Candidate of Medical Sciences (PhD), obstetrician-gynecologist and specialist in reproductive medicine at the «Mother and Child» Medical Center in Kyiv.
Ukraine
What was shown
The advanced reproductive age patient is not only a quantity problem — many present with reasonable antral follicle count, retrieve a normal number of oocytes, and still end the cycle with poor maturation and no euploid embryo. The talk reframes that picture as relative LH deficiency: the LH:FSH ratio drifts below 1 in the older patient, and the oocyte loses its competence support.
Key findings
Relative LH deficiency in patients over 38 affects oocyte quality more reliably than total oocyte yield. A high FSH dose without adequate LH support produces a paradoxical drop in mature-oocyte yield. The two-cell two-gonadotrophin model is most exposed at this age — theca-androgen supply, granulosa-aromatase activity and mitochondrial competence all depend on intact LH signalling.
