***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 
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    Input: 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 The commercial availability of highly purified , s.c . administered urinary follicle stimulating hormone ( FSH ) preparations for ovarian stimulation marked the beginning of a new era in the treatment of infertility . As these new formulations contain essentially no luteinizing hormone ( LH ) , supplemental LH may be needed for optimal folliculogenesis . It was the aim of this pilot study to compare fertilization rates , embryo morphology , implantation rates and pregnancy outcomes prospect ively in two age-matched patient groups : women who received highly purified FSH ( FSH-HP ) ( n = 17 ) , and women who received FSH-HP plus recombinant human LH ( rhLH , n = 14 ) throughout ovarian stimulation . All patients received mid-luteal pituitary down-regulation with s.c . gonadotrophin-releasing hormone agonist ( GnRHa ) ( leuprolide ) .  Mean implantation rates were 26.9 and 11.9 % in the FSH-HP only and FSH-HP + rhLH groups respectively . The mean clinical pregnancy/initiated cycle rate was 64.7 and 35.7 % for the FSH-HP only and FSH-HP + rhLH patients respectively . FSH-HP patients and FSH-HP + rhLH patients achieved clinical pregnancy/transfer rates of 68.8 and 45.5 % respectively . One patient in the FSH-HP + rhLH group had a spontaneous abortion ; no pregnancy losses occurred in the FSH-HP only group . There were more cancellations for poor ovarian response among FSH-HP + rhLH patients ( n = 3 ) than among FSH-HP patients ( n = 1 ) . The trend toward better pregnancy outcomes among patients who received FSH-HP without supplemental rhLH did not reach statistical significance . It is postulated that appropriate endogenous LH concentrations exist despite luteal GnRHa pituitary suppression , thereby obviating the need for supplemental LH administration BACKGROUND In anovulatory women undergoing ovulation induction , addition of recombinant human LH ( rLH ) to FSH treatment may promote the dominance of a leading follicle when administered in the late follicular phase . The objective of this study was to find the optimal dose of rLH that can maintain the growth of a dominant follicle , whilst causing atresia of secondary follicles . METHODS Women with infertility due to anovulation and over-responding to FSH treatment were r and omized to receive , in addition to 37.5 IU recombinant human FSH ( rFSH ) , either placebo or different doses of rLH ( 6.8 , 13.6 , 30 or 60 microg ) daily for a maximum of 7 days . The primary efficacy endpoint was the proportion of patients who had exactly one follicle > or = 16 mm on hCG day . RESULTS Among 153 enrolled patients , the five treatment groups were similar in terms of baseline characteristics . The proportion of patients with exactly one follicle > or = 16 mm ranged from 13.3 % in the placebo group to 32.1 % in the 30 microg rLH group ( P = 0.048 ) . The pregnancy rate ranged from 10.3 % in the 60 microg group to 28.6 % in the 30 microg rLH group . Adverse events were similar between groups . CONCLUSIONS In patients over-responding to FSH during ovulation induction , doses of up to 30 microg rLH/day appear to increase the proportion of patients developing a single dominant follicle ( > or = 16 mm ) . Our data support the ' LH ceiling ' concept whereby addition of rLH is able to control development of the follicular cohort PURPOSE The aim of this study was to assess the use of recombinant luteinizing hormone ( rLH ) supplementation in patients who experience a reduction in LH concentration during controlled ovarian hyperstimulation ( COH ) for IVF/ICSI . METHODS A multi-center prospect i ve r and omized controlled trial ( RCT ) was performed over three years . Two hundred and forty patients aged between 24 and 42 years undergoing IVF/ICSI treatment with a long down regulation ( LDR ) protocol were recruited .  LH was measured on the day FSH was started and again 6days later . 100 patients had a 50 % or greater reduction in LH levels  and these were r and omized to receive either recombinant LH ( rLH ) supplementation ( group 1 , n=43 ) or no additional rLH supplementation ( group 2 , n=57 ) . Group 1 received rLH 75IU daily from day 7 of FSH stimulation to the day of HCG trigger . RESULTS There were no differences in either live birth or clinical pregnancy rates per embryo transfer between the two groups ( 27.8 % vs. 37.0 % , p=0.39 , RR=0.75 , 95%CI 0.39 - 1.44 and 36.1 % vs. 43.5 % p=0.51 , RR=0.84 , 95%CI 0.5 - 1.48 , respectively ) . CONCLUSION In conclusion the addition of rLH in patients with a relative reduction in serum LH concentration during COH for IVF/ICSI did not improve live birth or clinical pregnancy rates . However the results were not conclusive and further large well- design ed RCTs are required to confirm these findings BACKGROUND The role of exogenous LH supplementation in ovarian stimulation is a matter of debate . Here we evaluate the impact of exogenous LH on oocyte yield and developmental competence in an oocyte donation programme . METHODS Oocyte donors were r and omized ( computer-generated r and omization list ) to groups stimulated with FSH alone or with a combination of FSH and LH after pituitary down-regulation with a GnRH agonist administered in the mid-luteal phase . RESULTS In donors with deep suppression of pituitary LH ( < 1 IU/l ) before the beginning of ovarian stimulation , the inclusion of exogenous LH result ed in an increase in the number of mature oocytes and good- quality zygotes and embryos as well as higher implantation rates when compared with stimulation with FSH alone . In contrast , the inclusion of exogenous LH in the stimulation of donors with pre-stimulation serum LH of > or=1 IU/l impaired embryo morphology and lowered the implantation rate , although it increased the number of metaphase II oocytes . CONCLUSIONS The inclusion of exogenous LH to the ovarian stimulation protocol can have beneficial or detrimental effects on oocyte yield and quality , depending on the level of endogenous LH . These data support the concept of a ' window ' for LH requirement in ovarian stimulation 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 Background : Based on classical two-cell , two-gonadotropin theory , in the follicle , follicle-stimulating hormone ( FSH ) and luteinizing hormone ( LH ) put on their main effects on the granulosa and theca cells . LH is essential for and rogens production . And rogens are used for estradiol production by granulosa cells . Profound suppression of LH concentrations in some normogonadotropic patients can cause several adverse effects . Objective : The main clinical purpose of this study was that normoresponder women treated with controlled ovarian super ovulation for IVF or ICSI may benefit from co-administration of rLH . Material s and Methods : 40 patients who were c and i date s for assisted reproductive technology ( ART ) were r and omly selected . In all patients long luteal protocol was used for ovulation induction . Patients were r and omly divided into two groups : Group 1 ( n=20 ) with st and ard long protocol ( GnRH agonist ) and r-FSH alone , Group 2 ( n=20 ) with st and ard long protocol ( GnRH agonist ) and r-FSH with r-LH . Results were statistically analyzed and compared in two 
    Output:
    
The evidence suggests that if the risk of cancellation due to low response following treatment with rFSH alone is 7 % , it will be between 4 % and 7 % using rLH combined with rFSH.We are uncertain whether use of rLH combined with rFSH improves rates of cancellation due to imminent OHSS compared to rFSH alone .
We found no clear evidence of a difference between rLH combined with rFSH and rFSH alone in rates of live birth or OHSS .
We found moderate quality evidence that the use of rLH combined with rFSH may lead to more ongoing pregnancies than rFSH alone .
There was also moderate- quality evidence suggesting little or no difference between the groups in rates of miscarriage .