What is the role of recombinant LH supplementation in IVF cycles?

ESHRE (2026) makes three separate recommendations on this, and all three point the same way. r-hFSH combined with r-hLH and r-hFSH alone are probably equally recommended for the general IVF population (conditional). The same for low responders (conditional). The same for women of advanced reproductive age, defined as 35 and over (conditional). "Equally recommended" means no demonstrated advantage for the combination. Describing rLH supplementation as necessary or essential in older women is not supportable on current evidence, and our previous version of this answer did exactly that. Related recommendations: Combining r-hFSH with hMG, from the start or mid-stimulation, is probably not recommended over either agent alone in normal and low responders (conditional). Adding low-dose hCG to FSH stimulation is probably not recommended (conditional). Administering recombinant LH for triggering final oocyte maturation is not recommended (strong). r-hFSH and hMG are equally recommended for stimulation (strong). The guideline discussion notes that while the rationale for adding LH activity in the mid-follicular phase is understood, the evidence shows no benefit in cumulative live birth rates.