New evidence is indicating a growing role of LH in promoting ovarian follicular growth and maturation, even at the early stages. LH seems to enhance the transition of follicles to the antral stage hence leading to an increase in the so-called functional ovarian reserve (recruitable antral follicles). Hypogonadotropic hypogonadism is characterized by low, and sometimes undetectable, serum LH and FSH levels, which may indeed explain the low anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) found in patients affected by this condition. We report here the cases of two young women affected by hypothalamic amenorrhea (HA) that presented for fertility treatment with very low functional ovarian reserve. The two patients were treated with exogenous LH for 1 and 2 months (extended LH administration: ELHA) at the dose of 187.5 IU LH every day and 150 IU LH every other day, respectively. In both the cases there was an increase in serum AMH levels and in the AFC. In one patient, the AMH and AFC increased from a baseline 1.3 ng/ml and 8 to 2.3 ng/ml and 14 at end of treatment, respectively. In the second case, serum AMH and AFC increased from 0.4 ng/ml and 6 to 1.6 ng/ml and 13, respectively. One patient underwent ovarian stimulation before and after ELHA, showing an increase in the number of mature oocytes recruited (3 versus 8 metaphase II (MII) oocytes before and after, respectively). The second patient underwent an IVF cycle after ELHA resulting in the retrieval of six MII oocytes and an ongoing pregnancy following transfer of a single blastocyst. Women with HA are characterized by chronic, low levels of gonadotrophins, which may impact not only on the cyclic recruitment of follicles but also the progression of small growing follicles through the first stages of folliculogenesis. Some women with HA may in fact show very low serum AMH and AFC. Our case series shows that the administration of LH at a dose of at least 150–187.5 IU every day or every other day may contribute to a clinically evident increase in the functional ovarian reserve (AFC), and probably accounts for a positive effect of LH on the progression of follicles throughout the early stages of folliculogenesis.

中文翻译：

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延长 LH 给药作为增加下丘脑闭经中可募集窦卵泡池的策略：来自病例系列的证据

新证据表明 LH 在促进卵巢卵泡生长和成熟方面的作用越来越大，即使在早期阶段也是如此。LH 似乎增强了卵泡向窦状阶段的转变，从而导致所谓的功能性卵巢储备（可募集的窦状卵泡）增加。低促性腺激素性腺功能减退症的特征是血清 LH 和 FSH 水平较低，有时检测不到，这确实可以解释受此病症影响的患者中抗苗勒管激素 (AMH) 水平和窦状卵泡计数 (AFC) 较低的原因。我们在此报告了两名受下丘脑性闭经 (HA) 影响的年轻女性的病例，她们接受了卵巢储备功能极低的生育治疗。这两名患者接受了剂量为 187 的外源性 LH 治疗 1 个月和 2 个月（延长 LH 给药：ELHA）。分别为每天 5 IU LH 和隔日 150 IU LH。在这两种情况下，血清 AMH 水平和 AFC 都有增加。在一名患者中，AMH 和 AFC 在治疗结束时分别从基线 1.3 ng/ml 和 8 增加到 2.3 ng/ml 和 14。在第二种情况下，血清 AMH 和 AFC 分别从 0.4 ng/ml 和 6 增加到 1.6 ng/ml 和 13。一名患者在 ELHA 前后接受了卵巢刺激，显示募集的成熟卵母细胞数量增加（前后分别为 3 个和 8 个中期 II (MII) 卵母细胞）。第二名患者在 ELHA 后接受了一个 IVF 周期，导致取回了 6 个 MII 卵母细胞，并在移植了一个囊胚后继续妊娠。患有 HA 的女性的特征是慢性、低水平的促性腺激素，这可能不仅影响卵泡的循环募集，而且影响小卵泡在卵泡发生第一阶段的进展。一些患有 HA 的女性实际上可能表现出非常低的血清 AMH 和 AFC。我们的病例系列表明，每天或每隔一天给予至少 150–187.5 IU 剂量的 LH 可能有助于临床上明显增加卵巢储备功能 (AFC)，并且可能解释 LH 的积极作用关于卵泡在卵泡发生早期阶段的进展。