To compare the addition of fixed dose additives namely recombinant luteinizing hormone (rLH), human menopausal gonadotropin (hMG), and letrozole to conventional doses of recombinant follicle-stimulating hormone (rFSH) on ovarian response and treatment outcome among women with poor ovarian reserve (POR) undergoing controlled ovarian stimulation for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).

 Materials and methods: In this prospective quasirandomized study, participants (N = 120) were randomized into three equal groups. rFSH with one additive (rLH, hMG, letrozole) was administered to patients from day 2/3 of cycle. Clinical, ongoing, and early pregnancy rates were primary outcome measures. Total number of oocytes retrieved, number of transferable embryos, cycle cancellation, and fertilization rates were secondary outcome measures. 

Results: Group A patients had higher clinical pregnancy rate (42.5%) than group B (20%) and group C (25%) with significant differences (P = 0.030) between groups A and B. Ongoing pregnancy rates were higher in group A (35%) compared to group B (12.5%) and group C (22.5%) with significant difference between groups A and B (P = 0.010). Number of patients with early pregnancy loss was numerically equivalent in all three groups. Group C showed significantly decreased levels of estradiol compared with other groups. No significant differences in secondary outcomes were observed among the groups. 

Conclusion: The current study demonstrates benefits of rLH in early stages of stimulation in patients with POR in terms of improvement in IVF/ICSI-associated outcomes. Further larger randomized studies are required to confirm this effect, given a modest sample size in this study.