Preferred clinical protocols for the management of LH/FSH deficiency: a practitioner opinion survey

BACKGROUND: Today's clinical guidelines do not fully address clinical situations associated with combined functional luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiencies linked to advanced maternal age, gonadotropin-releasing hormone agonist-related LH deficiency, low body mass index with eating disorders, or an unexpected hypo-response to ovarian stimulation. The objective of this fictional "case vignette" opinion survey was to characterize clinicians' treatment preferences in these contexts. METHOD: An international, four-investigator panel developed four fictional but realistic case vignettes, which were presented to practitioners via an online chatbot from June to September 2024. Each case featured two or three clinical scenarios with predetermined assisted reproductive technology outcomes, based on the chosen protocol. RESULTS: 132 gynaecologists and fertility specialists (primarily from France but also from 10 other European countries) completed at least one case vignette. Over 70% of practitioners included LH activity (primarily recombinant human LH (r-hLH)) at the first treatment opportunity, with the objective of increasing the oocyte yield and quality. r-hLH was preferred in 58-72% of instances, with the greatest preference for patients with a history of eating disorders or an unexpected hypo-response to ovarian stimulation (72% and 70%, respectively). Cost considerations were infrequently reported as a driver of treatment choices. CONCLUSION: The results of this survey of practitioners' perceptions of fictional but realistic scenarios suggest that the management of LH/FSH deficiency is complex and varies from specialist to specialist. In complex clinical scenarios, co-treatment with LH (and particularly r-hLH) was primarily selected; the practitioners considered that this choice might improve both oocyte yield and quality.