***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
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    Input: Background Recently , it has been demonstrated that , in patients down-regulated by GnRH analogues ( GnRHa ) , a short-term pre-treatment with recombinant LH ( rLH ) , prior to recombinant FSH ( rFSH ) administration , increases the number of small antral follicle prior to FSH stimulation and the yield of normally fertilized embryos . However , no data exist in the literature regarding the potential beneficial effect of " hCG priming " in controlled ovarian hyperstimulation ( COH ) through a long GnRH-a protocol , which binds the same receptor ( LH/hCGR ) , though it is a much more potent compared to LH . The primary aims of this study were to assess the effect of short-term pre-rFSH administration of hCG in women entering an ICSI treatment cycle on follicular development , quality of oocytes and early embryo development . The secondary endpoints were to record the effects on endometrial quality and pregnancy rate . Methods Patients with a history of at least one previous unsuccessful ICSI cycle were r and omly assigned into two groups to receive treatment with either a long protocol with rFSH ( control group ) or a long protocol with rFSH and pre-treatment with hCG ( hCG group ) . In particular , in the latter group , a fixed 7 days course of 200 IU/day hCG was administered as soon as pituitary desensitization was confirmed . Results The mean number of oocytes retrieved was not significantly different between the two treatment groups , although the percentage of mature oocytes tended to be higher but not significantly different in hCG-treated patients . The percentage of patients with more than one grade 3 embryos was higher in the pre-treatment group , which also showed a higher pregnancy rate . Conclusion All the above clinical observations , in conjunction with previous data , suggest a point towards a beneficial " hCG priming " effect in controlled ovarian hyperstimulation through a long GnRH-a down-regulation protocol , particularly in patients with previous ART failures OBJECTIVE To evaluate the effects of recombinant human luteinizing hormone ( rhLH ) supplementation on ovarian stimulation and implantation rate in down-regulated women of advanced reproductive age . DESIGN Prospect i ve r and omized study . SETTING University teaching hospital . PATIENT(S ) A total of 120 consecutive normogonadotropic infertile women > or = 35 years old undergoing their first cycle of IVF or intracytoplasmic sperm injection ( ICSI ) treatment . INTERVENTION(S ) Ovarian stimulation in a long agonist protocol with a combination of recombinant human follicle-stimulating hormone ( rhFSH ) and rhLH ( group 1 , n = 60 ) starting on day 6 of FSH stimulation until hCG at a daily fixed dose of 150 IU of rhLH , or with rhFSH alone ( group 2 , n = 60 ) . MAIN OUTCOME MEASURE(S ) Ovarian stimulation characteristics , ovum retrieval , and IVF/ICSI outcome . RESULT ( S ) The mean number of intermediate ( 10 - 14 mm ) and large ( > 14- < 18 mm ) but not leading ( > or = 18 mm ) follicles was significantly lower in group 1 on the day of hCG injection . The oocyte yield and maturity as well as the number of oocytes fertilized were significantly higher in group 2 than in group 1 . However , the number of patients having embryo transfer ( n = 55 in both treatment groups ) , the number and quality of embryos replaced , the implantation rate ( 20.6 % vs. 21.7 % ) and clinical pregnancy rates per embryo transfer ( 44 % vs. 45 % ) were similar in groups 1 and 2 . CONCLUSION ( S ) The rhLH supplementation does not increase ovarian response and implantation rates in patients of older reproductive age stimulated with rhFSH under pituitary suppression for assisted reproductive technologies ( ARTs ) OBJECTIVE To examine whether exogenous LH administration has a beneficial effect on the quality of oocytes , fertilization potential , as well as pregnancy rate in IVF-ET cycles . A r and omized trial comparing r-FSH versus r-FSH and LH was employed . STUDY DESIGN Forty-six infertile couples entering IVF-ET for the first time ( either tubal or male factor ) were divided after prospect i ve r and omization into two groups . In both groups the long protocol with GnRH-analogs was used . In group A , ovarian stimulation started with r-FSH ( 200 IU/day ) for the first four days . In group B , the stimulation protocol started with one amp hMG ( 75 IU FSH + 75 IU LH activity ) daily for four days , with simultaneous administration of r-FSH ( 150 IU/day ) . The outcome was compared . RESULTS Statistical difference was observed in the number of mature oocytes , the number of fertilized oocytes as well as the number of transferable embryos . In all cases , results were statistically significantly better ( p < 0.05 ) in group B. Clinical pregnancy rate , finally , was similar in the two groups . CONCLUSION The relatively small sample size does not allow a definitive conclusion for the important role of LH during early oocyte maturation . Our results , however , indicate a beneficial effect when small doses of LH are used for ovarian stimulation in IVF-ET cycles . This effect may be more important in cases in which few embryos are available for transfer Women undergoing intracytoplasmic sperm injection ( ICSI ) for male factor infertility were r and omly assigned to receive ovarian stimulation in a long agonist protocol with a combination of recombinant human FSH ( r-hFSH ; Gonal-F ) and recombinant human LH ( r-hLH ; Luveris ) ( n = 212 ) starting on day 6 of FSH stimulation until human chorionic gonadotrophin ( HCG ) at a daily fixed dose of 150 IU r-hLH , or with r-hFSH alone ( n = 219 ) . There was no significant difference in the number of metaphase II oocytes retrieved ( 10.3 versus 10.4 ) in patients treated with r-hFSH and r-hLH versus r-hFSH alone ; however , more embryos were transferred in the LH-supplemented group ( 2.9 versus 2.8 , P = 0.037 ) . Overall , the implantation rates were 22.9 versus 27.0 % in patients treated with r-hFSH and r-hLH versus with r-hFSH alone respectively ( NS ) . The respective numbers of MII oocytes retrieved in patients < 35 or > or=35 years were 11 versus 8.3 ( P = 0.010 ) for patients treated with r-hFSH alone , and 10.7 versus 9.3 ( NS ) for those given supplemental r-hLH ( 150 IU ) from day 6 . Implantation rates in patients < 35 years treated with r-hFSH were higher ( 30.7 % ) than those receiving r-hFSH and r-hLH , ( 23.5 % ) ( P = 0.068 ) . In patients > or=35 years , the implantation rates were 21.7 % for those patients supplemented with 150 IU r-hLH from day 6 of stimulation versus 15.7 % when treated with FSH alone ( NS ) . Younger patients therefore do not seem to benefit from an LH-supplemented ovarian stimulation protocol , but women > or=35 years undergoing assisted reproduction may benefit from using r-hLH in addition to r-hFSH During the follicular phase of the menstrual cycle , FSH stimulates follicular growth , granulosa cell aromatase activity , induction of LH receptors on the granulosa cell membrane , and estradiol secretion . As a result of negative feedback of estradiol on the pituitary , serum FSH concentrations decline . Despite the fall in FSH concentrations , the maturing follicle continues to develop to the preovulatory stage . In a prospect i ve r and omized trial , we tested the hypothesis that a key mechanism by which the dominant follicle continues to develop in the face of decreasing concentration of FSH is by acquiring LH responsiveness . In 24 women , pituitary gonadotropin secretion was down-regulated with a GnRH agonist . Follicular growth was then stimulated with recombinant human FSH ( r-hFSH ) until a 14-mm follicle was identified by ultrasound . The women were then r and omized to 1 of 4 groups for a 2-day period : continued r-hFSH treatment , substitution of r-hFSH with saline , low dose r-hLH ( 150 IU , twice daily ) , or high dose r-hLH ( 375 IU , twice daily ) . Serum estradiol concentrations in the women receiving saline declined by the end of the 2-day r and omization period . In contrast , serum estradiol concentrations continued to rise in women receiving either r-hFSH or r-hLH compared with those in the saline-treated group ( P < 0.05 ) . Pregnancies occurred in each of the gonadotropin treatment groups . These findings indicate that once FSH initiates follicular growth , either FSH or LH is capable of sustaining follicular estradiol production . Extrapolating these findings to the normal menstrual cycle suggests that the maturing follicle may continue to develop in the presence of diminishing FSH concentrations by acquiring the capacity to respond to LH BACKGROUND Poor ovarian response is a common clinical problem , affecting up to 26 % of IVF cycles . For these women , addition of recombinant luteinizing hormone ( rLH ) to ovarian hyperstimulation with recombinant FSH has a beneficial effect on ongoing pregnancy rates , but its effect on the yield of top- quality embryos is unknown . METHODS We conducted a r and omized controlled trial in women expected to respond poorly under ovarian hyperstimulation during their first IVF cycle [ all women aged 35 - 41 and women with FSH > 12 IU/ml and antral follicle count ( AFC ) ≤ 5 ] . Women were r and omly allocated to rFSH and rLH ( 2:1 ratio ) or rFSH alone ( control group ) after down-regulation with a GnRH agonist . The primary outcome was the proportion of top- quality embryos per woman on the day of transfer . Secondary outcomes were the number of stimulation days , the number of follicles ≥17 mm , the number of oocytes , the fertilization rate , the number of embryos , the number of women with ≥1 top- quality embryo , the biochemical , clinical and ongoing pregnancy rates and the miscarriage rate . RESULTS There were 116 women allocated to the rLH group and 128 allocated to the control group .  The proportion of top- quality embryos per woman was 17 % in the rLH group and 11 % in the control group [ mean difference 0.06 ; 95 % confidence interval ( CI ) -0.01 - 0.14 ] . In the rLH and control groups respectively , 47 ( 41 % ) and 41 ( 32 % ) women had at least one top- quality embryo on the day of transfer ( relative risk : 1.3 , 95 % CI 0.91 - 1.77 ) . The ongoing pregnancy rate was 13 versus 12 % ( relative risk : 1.1 ; 95 % CI 0.57 - 2.16 ) for the rLH group compared with the control group . CONCLUSIONS This study found no significant difference in embryo quality after the addition of rLH to rFSH for ovarian stimulation in women with poor ovarian reserve . CLINICAL TRIALS IDENTIFIER NTR1457 BACKGROUND Temporary exposure of follicles to increased levels of and rogens may enhance their sensitivity to FSH . The aim of this study was to increase the intraovarian and rogen level using aromatase inhibitors and hCG before controlled ovarian stimulation ( COH ) and to test this concept clinical ly . METHODS In a prospect i ve , non-r and omized study , 45 patients were treated in modified antagonist protocol s including early-follicular-phase down-regulation and and rogen priming before COH . All patients received cetrorelix , 3 mg s.c . , on cycle days 2 and 5 . Group I ( n=15 ) received no other pretreatment . Group II ( n=15 ) received 1 daily tablet of aromatase inhibitor , letrozole 2.5 mg , from cycle days 2 to 8 . Group III ( n=15 ) received letrozole as Group II and 1250 IU of hCG s.c . on cycle day 2 . From cycle day 8 , all patients were stimulated with highly purified menotrophin in a flexible antagonist protocol . RESULTS Aromatase inhibitor increased the level of testosterone in follicular fluid ( P<0.002 ) , but not in plasma . And rogen priming with aromatase inhibitor and hCG increased the number of good- quality embryos ( P=0.015 ) but did not increase the implantation rate . CONCLUSIONS The use of aromatase inhibitor before COH significantly influences the local endocrine environment before and during stimulation . And rogen priming with both aromatase inhibitor and hCG may result in more good- quality embryos 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 L 
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Results Three RCTs including 346 patients were included in this meta- analysis , which demonstrated that rLH priming did not increase ongoing pregnancy rate .
Conclusions This systematic review and meta- analysis has demonstrated that at present there is insufficient evidence that patients undergoing IVF/ICSI may benefit from rLH priming during the early follicular phase