Ovarian stimulation in ART: does one size fit for all?

Particular attention is given to the role of luteinizing hormone. Fatemi examines clinical situations in which a cycle develops sub-optimally because of reduced LH signaling activity, including cases involving polymorphism of the LH receptor. In such settings, adding recombinant LH can “rescue” the cycle by restoring adequate steroidogenic support for growing follicles and improving the synchrony of their maturation.

To support this approach, the speaker draws on the Rangar Maraju study, which randomized doses of recombinant LH. Without dwelling on specific numerical results, he uses this work to illustrate that dosing of LH-containing preparations should be a matter of deliberate titration rather than a single template applied uniformly to every category of patient.

From this follows the practical principle of personalization: before stimulation begins, a multifactorial assessment is needed, incorporating ovarian reserve markers (AMH, antral follicle count), age, the history of previous cycles and, where feasible, pharmacogenetic features. Such an evaluation makes it possible to identify in advance the patients for whom baseline FSH stimulation is insufficient and who would benefit from added LH activity.

The lecture stresses that personalizing a protocol is not complexity for its own sake but a way to improve both the efficacy and the safety of treatment. Choosing the right FSH-to-LH ratio, starting dose and protocol type reduces the risk of both poor response and excessive stimulation, while increasing the chance of obtaining an adequate number of mature, competent oocytes.

The practical takeaway for the clinic is simple yet demanding: no universal protocol exists, and the clinician's task is to build the stimulation scheme individually, grounded in the physiology of the specific patient, contemporary markers and the evidence on the role of LH. This approach turns ovarian stimulation from a standard procedure into a tool of precision reproductive medicine.