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.
OBJECTIVE
To determine if an elevated FSH:LH ratio predicts response in infertile patients undergoing controlled ovarian hyperstimulation (COH) for IVF-ET.


METHODS
Retrospective study.


METHODS
The Division of Reproductive Endocrinology at the Mount Sinai Medical Center, New York, New York.


METHODS
Seventy-four patients undergoing IVF-ET using similar protocols for COH with day 3 FSH, LH, and E2 testing available for analysis. All patients were < 41 years of age and had day 3 serum FSH < 15 mIU/mL (conversion to SI unit, 1.00).


METHODS
Follicle-stimulating hormone:LH ratio, day 8 serum E2, peak serum E2, cancellation rate, pregnancy rate, and number and size of follicles.


RESULTS
An FSH:LH ratio > or = 3.6 (group I) predicted a poor response to COH (sensitivity 85.7% and specificity 95%). There were no significant differences regarding day 3 serum FSH and ampules of gonadotropins used for COH. Group I (ratio > or = 3.6) patients responded to COH with lower day 8 E2 (97 +/- 18 versus 319 +/- 36 pg/mL; conversion factor to SI unit, 3.671), peak E2 (422 +/- 115 versus 2,368 +/- 183 pg/mL), and fewer follicles > 15 mm (1.3 +/- 0.5 versus 17.1 +/- 1.0). In group I the cycle cancellation rate (12/14) was significantly higher than the group II cycle cancellation rate (2/60) and pregnancy rate in group II (ratio < 3.6) was 25%.


CONCLUSIONS
The FSH:LH ratio may increase before a dramatic increase in serum FSH is observed and appears to be a useful marker of ovarian reserve.
Mukherjee
T
T
Department of Obstetrics and Gynecology, Mount Sinai Medical Center, New York, New York 10027, USA.
Copperman
A B
AB
Lapinski
R
R
Sandler
B
B
Bustillo
M
M
Grunfeld
L
L
D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood*; D005544:Forecasting; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007986:Luteinizing Hormone / Q000097:blood*; D008596:Menotropins / Q000627:therapeutic use*; D010053:Ovary / Q000187:drug effects*; D011237:Predictive Value of Tests; D012016:Reference Values; D012189:Retrospective Studies
D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone