{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:40:39Z","timestamp":1792611639867,"version":"4.5.0"},"reference-count":82,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"\n Background<\/jats:title>\n \n Luteinizing hormone (LH) activity plays a crucial role in follicular development, endometrial decidualization, and embryo implantation. We aimed to compare the efficacy and safety of gonadotropins with LH activity\n versus<\/jats:italic>\n recombinant follicle-stimulating hormone (rFSH) for controlled ovarian stimulation (COS).\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We included randomized clinical trials (RCTs) assessing gonadotropins with LH activity with or without rFSH\n versus<\/jats:italic>\n rFSH, or comparing different sources of LH activity, or different doses. Participants were women undergoing COS. The outcomes were\n live births<\/jats:italic>\n ,\n ongoing pregnancies<\/jats:italic>\n ,\n oocytes recovered per woman<\/jats:italic>\n ,\n metaphase II (MII) oocytes per woman<\/jats:italic>\n , and\n occurrence of ovarian hyperstimulation syndrome (OHSS)<\/jats:italic>\n . We searched the MEDLINE, Embase, and CENTRAL databases. We calculated the mean differences (MDs) and risk ratios (RRs) for continuous and dichotomous outcomes, respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We included 56 RCTs with 14,034 women. The evidence of gonadotropins with LH activity (\u00b1rFSH) when compared with rFSH alone probably results in little to no difference in live birth (RR\u00a0=\u00a01.07, 95%CI = 0.96\u20131.18; 17 studies, moderate certainty of evidence) and ongoing pregnancy (RR\u00a0=\u00a01.03, 95%CI = 0.95\u20131.12; 19 studies, moderate certainty of evidence), may result in a slight reduction in the number of oocytes retrieved (MD = \u22120.50, 95%CI = \u22120.88 to \u22120.12,\n I<\/jats:italic>\n 2<\/jats:sup>\n = 81.1%; 46 studies, low certainty of evidence), and is very uncertain in the number of MII oocytes (MD = \u22120.49, 95%CI = \u22120.93 to \u22120.05,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a086%; 30 studies, very low certainty of evidence). However, it probably does not increase OHSS compared with rFSH alone (RR\u00a0=\u00a00.80, 95%CI = 0.61\u20131.03,\n I<\/jats:italic>\n 2<\/jats:sup>\n \u00a0=\u00a017.1%; 19 studies, moderate certainty of evidence). Subgroup analysis by downregulation protocol, ovarian reserve, and age showed some differences in the effects between the compared groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The evidence of gonadotropins with LH activity (\u00b1rFSH) when compared with rFSH alone probably results in little to no difference in live birth and ongoing pregnancy. However, there is a slight reduction in the number of oocytes retrieved. Moreover, they are safer than rFSH alone because they probably do not increase OHSS. Therefore, based on our review, the benefit\u2013risk balance favors the addition of an LH-active gonadotropin for the prevention of OHSS. More studies are needed to determine the effects in specific populations.<\/jats:p>\n <\/jats:sec>\n \n Systematic Review Registration<\/jats:title>\n \n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42024572731<\/jats:ext-link>\n , identifier CRD42024572731.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fendo.2026.1792900","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:34:48Z","timestamp":1776832488000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Luteinizing hormone activity in ovarian stimulation: comparative efficacy and safety of gonadotropins versus recombinant follicle-stimulating hormone\u2014a systematic review and meta-analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Juan Jose","family":"Espin\u00f3s","sequence":"first","affiliation":[{"name":"Fertty Foundation","place":["Barcelona, Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona (UAB)","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Angel","family":"Checa","sequence":"additional","affiliation":[{"name":"Fertty Foundation","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Villegas-Arbelaez","sequence":"additional","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona (UAB)","place":["Barcelona, Spain"]},{"name":"Clinical Epidemiology and Public Health Service, Hospital de la Santa Creu i Sant Pau","place":["Barcelona, Spain"]},{"name":"Institut de Recerca Sant Pau","place":["Barcelona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00aa Jos\u00e9","family":"Mart\u00ednez-Zapata","sequence":"additional","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona (UAB)","place":["Barcelona, Spain"]},{"name":"Clinical Epidemiology and Public Health Service, Hospital de la Santa Creu i Sant Pau","place":["Barcelona, Spain"]},{"name":"Institut de Recerca Sant Pau","place":["Barcelona, Spain"]},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP)","place":["Madrid, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"105154","DOI":"10.1016\/j.rbmo.2025.105154","article-title":"Disentangling the current role of LH activity in assisted reproduction: from biology to patient personalization","volume":"52","author":"Bellver","year":"2025","journal-title":"Reprod BioMed Online"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2019.00282","article-title":"An observational retrospective cohort trial on 4,828 IVF cycles evaluating different low prognosis patients following the POSEIDON criteria","volume":"10","author":"Levi-Setti","year":"2019","journal-title":"Front 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