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Found These Abstracts which explain Rationale

August 23 2011 at 8:17 PM
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DeeinNYC  (no login)

Response to SIRM is against the use of menopur

Here is what the abstract had to say about LH:

"It is important to recognize that the pituitary gonadotropins, LH and FSH, while both playing a pivotal role in follicle development, have different primary sites of action in the ovary. The action of FSH is mainly directed toward granulosa cell (which line the inside of the follicles) proliferation and estrogen production. LH, on the other hand, acts primarily on the ovarian stroma (the connective tissue that surrounds the follicles) to produce androgens. Only a small amount of testosterone is necessary for optimal estrogen production. Over-production has a deleterious effect on granulosa cell activity, follicle growth/development, egg maturation, fertilization potential and subsequent embryo quality. Furthermore, excessive ovarian androgens can also compromise estrogen-induced endometrial growth and development.

In conditions such as polycystic ovarian syndrome (PCOS), which is characterized by increased blood LH levels, there is also an increased ovarian androgen production. It is therefore not surprising that poor egg/embryo quality and inadequate endometrial development are often features of this condition. The use of LH-containing preparations such as Pergonal and Repronex further aggravates this effect. Thus we strongly recommend against the exclusive use of such products, in PCOS patients, preferring FSH-dominant products such as Follistim and Gonal F. While it would seem prudent to limit LH exposure in all cases of COH, this appears to be more relevant in older women, who tend to be more sensitive to LH."

Microflare GnRHa protocols

Another approach to COH is by way of so-called flare protocols. This involves initiating gonadotropin therapy simultaneous with the administration of GnRH agonist. The intent is to deliberately allow Lupron/Lucrin to affect an initial surge (flare) in pituitary FSH release so as to augment ovarian response to the gonadotropin medication. Unfortunately, this approach represents a double-edged sword as the resulting increased release of FSH is likely to be accompanied by a similar rise in blood LH levels that could evoke excessive ovarian stromal androgen production. The latter could potentially compromise egg quality, especially in older women, and to women with conditions like polycystic ovarian syndrome (PCOS) whose ovaries have increased sensitivity to LH. We believe that in this way, microflare protocols potentially can hinder endometrial development; compromise egg/embryo quality and reduce IVF success rates. Accordingly, we prefer to avoid flare protocols.

Okay...the above is in first link below to an abstract on SIRM protocols:

This is a link to a study they did re: IVF patients that were at least 42....they mention some of the same issues and they had an incredible success rate and all had prior UVF failures: :
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  • what day do you add LH? - Anonymous on Aug 23, 2011, 8:26 PM
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