***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The study evaluated the proportion of patients whose pituitary gl and s respond with a sharp decrease in  luteinizing hormone ( LH ) levels when exposed to a conventional dose of 0.25 mg gonadotropin releasing hormone ( GnRH ) antagonist in a prospect i ve , single-center , non-r and omized , proof-of-concept study . Fifty women eligible for in vitro fertilization ( IVF ) received recFSH ( Gonal-F ) from day 2 or 3 of menstrual period . Basal estradiol , progesterone , and LH were measured on the same day and 4 - 5 days later–-immediately before GnRH antagonist 0.25 mg administration , and 24 hours after its administration . Responders were defined as “ normal ” if 24 hours after the first GnRH antagonist injection , LH level was ≥50 % of the pre-injection level and as “ over-suppressed ” if it was < 50 % of the pre-injection level . Twelve patients ( 26 % of the total ) were “ over-suppressed ” with a mean LH level of 37 % of the level 24 hours earlier . These patients also demonstrated a significant decrease in estradiol rise during the first 24 hours after initial antagonist administration . This effect was reversed for the rest of the stimulation period during which recLH ( Luveris , 150 IU/day ) was added to the “ over-suppressed . ” If proven advantageous in terms of pregnancy rate , this approach to individualized treatment would be easy to implement . Trial registration : Clinical Trials.gov Identifier : NCT01936077 BACKGROUND The role of LH in sensitizing antral follicles to FSH is unclear . LH is required for normal hormone production and normal oocyte and embryo development , but follicular responses to LH may depend upon the stage of development . Potential roles at the early follicular phase were explored in a clinical setting by employing a sequential approach to stimulation by recombinant human ( r-h ) LH followed by r-hFSH in women who were profoundly down-regulated by depo GnRH agonist . METHODS We employed a multi-centre , prospect i ve , r and omized approach . Women ( n = 146 ) were treated in a long course high-dose GnRH agonist ( Decapeptyl , 4.2 mg s.c . ) protocol and were r and omized to receive r-hLH ( Luveris , 300 IU/day ) for a fixed 7 days , or no r-hLH treatment . This was followed by a st and ard r-hFSH stimulation regime ( Gonal-F , 150 IU/day ) . Ultrasound and hormone assessment s of responses were measured at the start of r-hLH treatment , on FSH stimulation Days 0 and 8 and at the time of HCG administration . RESULTS The LH treatment was associated with increased small antral follicles prior to FSH stimulation ( P = 0.007 ) , and an increased yield of normally fertilized ( 2 PN ) embryos ( P = 0.03 ) . There was no influence of the r-hLH pretreatment upon hormone profiles or ultrasound assessment s during the FSH phase . Anti-mullerian hormone increased in both groups during the week prior to FSH stimulation ( P = 0.002 ) . CONCLUSIONS This sequential approach to the use of r-hLH in st and ard IVF showed a possible modest clinical benefit . The results support other recent work exploring up-regulated and rogen drive upon follicular metabolism indicating that clinical benefit may be obtainable after further practical explorations of the concept The impact of suppressed concentrations of circulating luteinizing hormone ( LH ) during ovarian stimulation on the outcome of in-vitro fertilization or intracytoplasmic sperm injection treatment in 200 consecutive , normogonadotrophic women ( couples ) was analysed retrospectively . A st and ard stimulation protocol with mid-luteal gonadotrophin-releasing hormone ( GnRH ) agonist down-regulation and ovarian stimulation with recombinant follicle stimulating hormone ( FSH ) was used in all cases . Blood was sample d from each woman on stimulation days 1 and 8 for analysis of oestradiol and LH in serum . A threshold value of serum LH of 0.5 IU/l on stimulation day 8 ( S8 ) was chosen to discriminate between women with low or ' normal ' LH concentrations . Low concentrations of LH on S8 ( < 0.5 IU/l ) were found in 49 % ( 98/200 ) of the women . This group of women was comparable with the normal LH group with regard to pre-treatment clinical parameters , and to the parameters characterizing the stimulation protocol with the exception of serum oestradiol concentration , which on S8 was significantly lower than in the normal LH group ( P < 0.001 ) . The proportion of positive pregnancy tests was similar in the two groups ( 30 % versus 34 % per started cycle ) , but the final clinical treatment outcome was significantly different , with a five-fold higher risk of early pregnancy loss ( 45 % versus 9 % ; P < 0.005 ) in the low LH group and consequently a significantly poorer chance of delivery than in the normal LH group . It is concluded that a substantial proportion of normogonadotrophic women treated with GnRH agonist down-regulation in combination with FSH , devoid of LH activity , experience LH suppression , which compromises the treatment outcome . Whether these women would benefit from supplementation with recombinant LH or human menopausal gonadotrophin during ovarian stimulation , remains to be proven in the future by prospect i ve r and omized trials A multicentre , open-label , r and omized study of the gonadotrophin-releasing hormone ( GnRH ) antagonist ganirelix ( Orgalutran((R))/Antagon((TM ) ) ) was performed in women undergoing ovarian stimulation with recombinant FSH ( rFSH : Puregon((R ) ) ) . The study was design ed as a non-inferiority study using a long protocol of buserelin ( intranasal ) and rFSH as a reference treatment . A total of 730 subjects was r and omized in a treatment ratio of 2:1  ( ganirelix : buserelin ) using an interactive voice response system which stratified for age , type of infertility and planned fertilization procedure [ IVF or intracytoplasmic sperm injection ( ICSI ) ] . The median duration of  GnRH analogue treatment was 5 days in the ganirelix group and 26 days in the buserelin group , whereas the median total rFSH dose was 1500 IU and 1800 IU respectively . In addition , in the ganirelix group the mean duration of stimulation was 1 day shorter . During ganirelix treatment the incidence of LH rises ( LH > /=10 IU/l ) was 2.8 % versus 1.3 % during rFSH stimulation in the buserelin group . On the day of triggering ovulation by human chorionic gonadotrophin ( HCG ) , the mean number of follicles > /=11 mm diameter was 10.7 and 11.8 , and the median serum oestradiol concentrations were 1190 pg/ml and 1700 pg/ml in the ganirelix and buserelin groups respectively . The mean number of oocytes per retrieval was 9.1 and 10.4 respectively , whereas the mean number of good quality embryos was 3.3 and 3.5 respectively . The fertilization rate was equal in both groups ( 62.1 % ) , and the same mean number of embryos ( 2.2 ) was replaced . The mean implantation rates were 15.7 % and 21.8 % , and the ongoing pregnancy rates per attempt were 20.3 % and 25.7 % in the ganirelix and buserelin groups respectively . Evaluation of all safety data indicated that the ganirelix regimen was safe and well tolerated . The overall incidence of ovarian hyperstimulation syndrome was 2.4 % in the ganirelix group and 5.9 % in the reference group . The results of this study support a safe , short and convenient treatment regimen of ganirelix , result ing in a good clinical outcome for patients undergoing ovarian stimulation for IVF or ICSI Although the fundamental significance of both LH and FSH for adequate ovarian folliculogenesis and steroidogenesis has been extensively discussed , the clinical implication of recombinant ( r ) LH to rFSH for ovarian stimulation employing the GnRH antagonist protocol remains to be eluci date d. The aim of this prospect i ve r and omized controlled study was to explore whether rLH supplementation to rFSH following GnRH antagonist has an added value to the late follicular ovarian steroidogenesis in the advanced reproductive aged women OBJECTIVE To analyze the impact of LH administration on cycle outcome in ovarian stimulation with GnRH antagonists . DESIGN R and omized , open-label , controlled trial performed in two age subgroups .  Recombinant ( r ) FSH versus rFSH + rLH administration was compared . SETTING University-affiliated private infertility clinic . PATIENT(S ) Up to 35 years old ( n = 380 ) and aged 36 to 39 years ( n = 340 ) , undergoing their first or second IVF cycle . INTERVENTION(S ) Recombinant LH administration since stimulation day 1 . MAIN OUTCOME MEASURE(S ) Implantation rate , ongoing pregnancy rate . RESULT ( S ) In the young population , implantation rates were similar : 27.8 % versus 28.6 % , odds ratio ( OR ) 1.03 ( 95 % confidence interval [ CI ] 0.73 - 1.47 ) , as was the ongoing pregnancy rate per started cycle : 37.4 % versus 37.4 % , OR 1.0 ( 95 % CI 0.66 - 1.52 ) . In older patients , the implantation rate was significantly higher in the rFSH + rLH group : 26.7 % versus 18.6 % , OR 1.56 ( 95 % CI 1.04 - 2.33 ) . Ongoing pregnancy rates per started cycle were 33.5 % versus 25.3 % , OR 1.49 ( 95 % CI 0.93 - 2.38 ) . CONCLUSION ( S ) Recombinant LH administration significantly increased the implantation rate in patients aged 36 to 39 years . A clinical ly relevant better ongoing pregnancy rate per started cycle was observed , although the difference was not statistically significant . Patients younger than 36 years do not obtain any benefit from rLH administration OBJECTIVE To evaluate clinical and endocrinological effects of intranasal ( IN ) vs. subcutaneous ( SC ) GnRH-a for pituitary down-regulation combined with hMG vs. rFSH . DESIGN Prospect i ve , r and omized study . SETTING University hospital , IVF unit . PATIENT(S ) Three hundred seventy-nine normogonadotropic women eligible for IVF or ICSI . INTERVENTION(S ) R and omization to intranasal ( IN ) or SC GnRH-a and to hMG or rFSH . MAIN OUTCOME MEASURE(S ) Oocytes retrieved , embryos developed , clinical pregnancy , and delivery rates . Serum hormone concentrations on stimulation days 1 ( S1 ) and 8 ( S8 ) , and oocyte pick-up ( OPU ) day . RESULT ( S ) After r and omization , four groups were formed : IN/hMG ( n = 100 ) , IN/FSH ( n = 98 ) , SC/hMG ( n = 89 ) , and SC/FSH ( n = 92 ) . Mean number of oocytes retrieved and of transferable and transferred embryos were similar in the four groups . Clinical pregnancy rate per started cycle was significantly higher in the IN/HMG group than in the SC/FSH group ( P<.05 ) and was intermediate in the two remaining groups . Se-LH on S8 in the two SC groups was significantly lower than in the two IN groups . Se-E2 on S8 in the SC/FSH group was significantly lower than in the other three groups . CONCLUSION ( S ) The clinical and endocrinological outcome in IVF and ICSI-treated normogonadotropic women is significantly influenced by mode of down-regulation as well as gonadotropin formulation OBJECTIVE To investigate the role of exogenous LH in controlled ovarian hyperstimulation for assisted reproductive technologies . DESIGN Prospect i ve r and omized study . SETTING SISMER fertility unit . PATIENT(S ) Women showing a hyporesponsiveness to FSH under GnRH agonist down-regulation were r and omized into three groups : group A ( n = 54 ) received an increased dosage of FSH ; group B ( n = 54 ) was administered recombinant LH in addition to the increased dose of FSH ;  group C ( n = 22 ) was given additional FSH and LH using hMG as a combined drug . Fifty-four age-matched women with no need to increase the FSH dose were included as a control group ( D ) . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Implantation and live birth rate per started cycles . RESULT ( S ) In group B , the pregnancy and implantation rates were statistically higher when compared with groups A and C and did not differ from the control group for normal response . The live birth rate 
    Output:
    
RESULTS Evidence exists to show that rLH supplementation seems to have added value for pregnancy achievement in women with poor ovarian response and in women ≥35 years of age employing the GnRH agonist protocol , while the evidence is still debatable when the GnRH antagonist is administered .
In the general infertile population  , rLH supplementation does not have added value in the GnRH-antagonist cycles while the evidence is still controversial when the GnRH agonist is employed .
An accurate definition of the LH threshold in GnRH analogue treated cycles may contribute to the discussion of which subgroups of women may benefit from adjuvant rLH therapy