P-680 Management of LH/FSH deficiency among assisted reproduction specialists in Spain: a Delphi consensus
Authors: Álvaro Mercadal B , Gil Arribas E , Lobo Martínez S , Muñoz Muñoz E , Álvarez Pinochet C , Pérez Calvo A , Ortega Ricondo S , Landeras Gutiérrez J , Álvarez Almodóvar M , Saucedo de la Llata E , Garcia Fernandez C.I , Llácer Aparicio J , Peñarrubia Alonso J 
Published: June 2022

Abstract

Study question
The objective of the study is to establish a consensus on the management of LH/FSH deficiency in assisted reproduction in Spain

Summary answer
It is important to consider the diverse factors that can lead to a LH/FSH deficiency in order to optimize its management and improve reproductive outcomes.

What is known already
Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) deficiency decrease women fertility, due to the compromised gametogenesis and steroidogenesis. Within the context of fertility and medically assisted reproduction (MAR), there are several factors (such as age, polymorphisms in gonadotropins and their receptors, and the use of gonadotrophin-releasing hormone analogue protocols) that might lead to hypo-response to ovarian stimulation and function. Therefore, the International Committee for Monitoring Assisted Reproduction Technologies (ICMART) has highlighted the importance of the action of the gonadotropin in determining LH/FSH deficiency.

Study design, size, duration
An online, two-round Delphi consensus comprising a 21-statement questionnaire was conducted from December 2021 to January 2022.

Participants/materials, setting, methods
The questionnaire included 21 statements concerning the action of LH/FSH in altered physiological conditions, the clinical presentation of LH/FSH deficiency and its importance in assisted reproduction. For each statement, a consensus was established if 70% was reached. The questionnaire was initially sent via email to 78 gynaecologists experts in assisted reproduction.

Main results and the role of chance
Responses from 45 and 42 assisted reproduction Spanish experts were collected in the first and second round, respectively. Overall, consensus was reached in 10 out of 21 statements (&lt;50% of the statements), being two of the statements a consensus in the disagreement. Among other statements, participants agreed on: the use of long-term previous contraceptives can increase the risk of hypo-response in patients with associated risk factors regarding clinical features of LH/FSH deficiency (77.8%) and the use of POSEIDON classification in order to individualize the treatment of poor prognosis patients (71.4%). The statement that described the fact of considering baseline LH serum levels before stimulation and the consideration that LH levels should be monitored along the stimulation cycle reached a consensus in the disagreement with 82.2% and 76.2% respectively.

Limitations, reasons for caution
The diversity in the level of agreement of some statements should be further investigated.

Wider implications of the findings
It is important to consider the diverse factors that can lead to a LH/FSH deficiency in order to optimize its management and achieve an improvement in reproductive outcomes. Additionally, the diverse level of agreement of some statements should be further investigated and might reflect the variability of MAR clinical practice.

Trial registration number
not applicable