ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Reproduction
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1498062
Management of LH/FSH deficiency among assisted reproduction specialists in Spain: a Delphi consensus
Provisionally accepted
Sonia Lobo1Beatriz Álvaro2Joana Peñarrubia3
Carlos Ignacio García Fernández4Elisa Gil3
Joaquin Llacer5*- 1La Paz Hospital, Madrid, Asturias, Spain
- 2Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
- 3IVI-RMA (Spain), Madrid, Madrid, Spain
- 4Merck Sharp and Dohme Corp (Spain), Madrid, Catalonia, Spain
- 5Ginefiv-GeneraLife, Madrid, Spain
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency can decrease women fertility, due to compromised gametogenesis and steroidogenesis. Several factors, like age, LH/FSH and their receptor polymorphisms, and gonadotrophin-releasing hormone analogue protocols; might result in a hypo-response to ovarian stimulation. The International Committee for Monitoring Assisted Reproduction Technologies (ICMART) highlighted the importance of addressing LH/FSH deficiency for a successful outcome. The aim was to understand if consensus exists on LH/FSH deficiency management among specialists in assisted reproduction based on the latest available evidence. Methods: An online, two-round Delphi consensus questionnaire was conducted from December 2021 to January 2022. The questionnaire comprised 21 statements concerning the action of LH/FSH in disrupted physiological conditions, clinical presentation of LH/FSH deficiency and its importance in assisted reproduction. A 70% agreement threshold was established for each statement. Results: Responses from 45 and 42 assisted reproduction Spanish specialists were gathered in the first and second rounds. Consensus was reached in almost half (10/21) of the statements. Participants mostly agreed on the relevance of LH/FSH deficiency due to a reduction of the action and production of gonadotropins, the importance of the effect of different glycosylation variants and age in LH/FSH action and of estradiol (E2) levels during ovulation discharge, the use of POSEIDON criteria to individualize the treatment of patient with poor prognosis, and the use of recombinant LH supplementation in low response patients.It is important to consider the diverse factors that can lead to LH/FSH deficiency in order to optimize its management and improve reproductive outcomes.
Keywords: Luteinizing Hormone, Follicle-stimulating hormone, deficiency, delphi, consensus
Received: 12 Feb 2025; Accepted: 11 Jul 2025.
Copyright: © 2025 Lobo, Álvaro, Peñarrubia, García Fernández, Gil and Llacer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Joaquin Llacer, Ginefiv-GeneraLife, Madrid, Spain
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.