Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

Correlation of the Day 3 FSH/LH Ratio and LH Concentration in Predicting IVF Outcome

Authors
Sudha Prasad 1
Teena Gupta 1
Aabha Divya 2
1 IVF and Reproductive Biology Centre, Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
2 All India Institute of Medical Sciences, New Delhi, India
Abstract
Background: This study was undertaken to evaluate the role of day 3 FSH/LH ratio and day 3 LH level as predictors of IVF cycle outcomes. Methods: This prospective observational study was undertaken in the IVF and Reproductive Biology Centre and Lok Nayak Hospital, affiliated to Maulana Azad Medical College, in New Delhi, India. The study included 105 women who underwent controlled ovarian hyperstimulation for in vitro fertilization. Characteristics of IVF cycles and outcomes were studied in patient subgroups based on day 3 FSH/LH ratio (3 and ≤3 mIU/ml). The student t-test, Bartlett's test, chi-squred and Fisher's exact test, and linear regression model were used for data analysis. A p-value less than 0.05 was considered as statistically significant. Results: Women with an elevated FSH/LH ratio ≥2 (n=31) required higher doses of gonadotrophins (3019.34 vs. 2482.43 IU). The outcome of IVF was poor in these patients and they had fewer number of mature follicles (>16 mm) (5.44 vs. 6.09), less E2/mature follicle ratio (4.65 vs. 6.36), fewer retrieved oocytes (6.67 vs. 9.09) and fewer pregnancy rates (11.1% vs. 33.8%). On the other hand, patients with low basal LH levels (≤3 mIU/ml) did not differ significantly in terms of response to controlled ovarian hyperstimulation except for fewer number of retrieved oocytes (7.33 vs. 7.91) but there was a trend towards poor pregnancy rates (7.33 vs. 7.91) but there was a trend towards poor pregnancy rates as compared to subgroup with LH levels >3 mIU/ml. Conclusion: Elevated day 3 FSH/LH ratio is associated with inferior outcome in IVF treatment cycles and it could be used as an additional predictor of decreased ovarian reserve.
Keywords
FSH
IVF outcome
LH
Ovarian hyperstimulation
ovarian reserve
  1. Lenton EA, Sexton L, Lee S, Cooke ID. Progressive changes in LH and FSH and LH: FSH ratio in women throughout reproductive life. Maturitas. 1988;10 (1):35-43.
  2. Lévy DP, Navarro JM, Schattman GL, Davis OK, Rosenwaks Z. The role of LH in ovarian stimulation: exogenous LH: let's design the future. Hum Reprod. 2000;15(11):2258-65.
  3. Liu KE, Greenblatt EM. Elevated day 3 follicle-stimulating hormone/luteinizing hormone ratio >or= 2 is associated with higher rates of cancellation in in vitro fertilization-embryo transfer cycles. Fertil Steril. 2008;90(2):297-301.
  4. Noci I, Maggi M, Fuzzi B, Biagiotti R, Ricci F, Marchionni M. Effects of low day 3 luteinizing hormone levels on in vitro fertilization treatment outcome. Gynecol Endocrinol. 2000;14(5):321-6.
  5. Mukherjee T, Copperman AB, Lapinski R, Sandler B, Bustillo M, Grunfeld L. An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. Fertil Steril. 1996;65(3):588-93.
  6. Stensen MH, Tanbo T, Storeng R, Byholm T, Fèdor-csak P. Routine morphological scoring systems in assisted reproduction treatment fail to reflect age-related impairment of oocyte and embryo quality. Reprod Biomed Online. 2010;21(1):118-25.
  7. Watt AH, Legedza AT, Ginsburg ES, Barbieri RL, Clarke RN, Hornstein MD. The prognostic value of age and follicle-stimulating hormone levels in women over forty years of age undergoing in vitro fertilization. J Assist Reprod Genet. 2000;17(5):264-8.
  8. Muasher SJ, Oehninger S, Simonetti S, Matta J, Ellis LM, Liu HC, et al. The value of basal and/or stimulated serum gonadotropin levels in prediction of stimulation response and in vitro fertilization outcome. Fertil Steril. 1988;50(2):298-307.
  9. Smotrich DB, Widra EA, Gindoff PR, Levy MJ, Hall JL, Stillman RJ. Prognostic value of day 3 estradiol on in vitro fertilization outcome. Fertil Steril. 1995;64(6):1136-40.
  10. Navot D, Rosenwaks Z, Margalioth EJ. Prognostic assessment of female fecundity. Lancet. 1987;2(85 60):645-7.
  11. Seifer DB, Scott RT Jr, Bergh PA, Abrogast LK, Friedman CI, Mack CK, et al. Women with declining ovarian reserve may demonstrate a decrease in day 3 serum inhibin B before a rise in day 3 follicle-stimulating hormone. Fertil Steril. 1999;72(1): 63-5.
  12. Winslow KL, Toner JP, Brzyski RG, Oehninger S C, Acosta AA, Muasher SJ. The gonadotropin releasing hormone agonist stimulation test--a sensitive predictor of performance in the flare-up in vitro fertilization cycle. Fertil Steril. 1991;56(4): 711-7.
  13. Tomas C, Nuojua-Huttunen S, Martikainen H. Pretreatment transvaginal ultrasound examination predicts ovarian responsiveness to gonadotrophins in in-vitro fertilization. Hum Reprod. 1997;12(2): 220-3.
  14. Zaidi J, Barber J, Kyei-Mensah A, Bekir J, Campbell S, Tan SL. Relationship of ovarian stromal blood flow at the baseline ultrasound scan to subsequent follicular response in an in vitro fertilization program. Obstet Gynecol. 1996;88 (5):779-84.
  15. Barroso G, Oehninger S, Monzó A, Kolm P, Gibbons WE, Muasher SJ. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet. 2001;18(9):499-505.
  16. Shrim A, Elizur SE, Seidman DS, Rabinovici J, Wiser A, Dor J. Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response. Reprod Biomed Online. 2006;12(4):418-22.
  17. Balasch J, Vidal E, Peñarrubia J, Casamitjana R, Carmona F, Creus M, et al. Suppression of LH during ovarian stimulation: analysing threshold values and effects on ovarian response and the outcome of assisted reproduction in down-regulated women stimulated with recombinant FSH. Hum Reprod. 2001;16(8):1636-43.
  18. Hillier SG. The Parkes lecture: controlled ovarian stimulation in women. J Reprod Fertil. 2000;120 (2):201-10.
  19. Taymor ML. The regulation of follicle growth: some clinical implications in reproductive endocrinology. Fertil Steril. 1996;65(2):235-47.
  20. Muasher SJ, Abdallah RT, Hubayter ZR. Optimal stimulation protocols for in vitro fertilization. Fertil Steril. 2006;86(2):267-73.
  21. Kolibianakis EM, Kalogeropoulou L, Griesinger G, Papanikolaou EG, Papadimas J, Bontis J, et al. Among patients treated with FSH and GnRH analogues for in vitro fertilization, is the addition of recombinant LH associated with the probability of live birth? A systematic review and meta-analysis. Hum Reprod Update. 2007;13(5):445-52.
Journal of Reproduction & Infertility
Volume 14, Issue 1
Winter 2013
Pages 23-28