The prognostic value of basal luteinizing hormone:follicle-stimulating hormone ratio in the treatment of patients with polycystic ovarian syndrome by assisted reproduction techniques

One of the main endocrinological disturbances in patients withpolycystic ovarian syndrome (PCOS) is the increased baselineconcentrations of luteinizing hormone (LH) and consequentlya high LHrfollicle-stimulating hormone (FSH) ratio. The aimof this study was to assess the relationship between the baselineLH:FSH ratio with the stimulation response and the miscarriagerisk in PCOS women stimulated for assisted reproduction techniques(ART) with and without gonadotrophin-releasing hormone analogue(GnRHa). Two groups of PCOS patients were analysed retrospectively.Group A (n = 20, 20 cycles) consisted of women stimulated withhuman menopausal gonadotrophin (HMG), and group B (n = 128,162 cycles) comprised women stimulated with buserelin-long/HMG.LH and FSH concentrations were measured during the early follicularphase (days 4–6) in a preceding spontaneous or progestininducedcycle. The following parameters were assessed: number of folliclesdeveloped, number of oocytes obtained and percentage of matureoocytes, as well as number of abortions and live births. Ingroup A, the baseline LH:FSH ratio was correlated inverselywith the number of follicles developed (P < 0.05), the numberof oocytes obtained (P < 0.05) and the percentage of matureoocytes (P < 0.05). In group B, no correlation was foundbetween the LH:FSH ratio and the number of follicles and oocytes,because their numbers were relatively constant irrespectiveof the baseline LH:FSH ratio, but a significant inverse correlationwas noted with the percentage of mature oocytes (P < 0.001).However, a comparison of the slopes of the curve indicated abetter correlation between the LH:FSH ratio and the percentageof mature oocytes in group A than in group B (P < 0.05).These findings were also confirmed when patients were subdividedaccording to the LH:FSH ratio (<3 or 3=3). Furthermore, inwomen who miscarried, the mean LH:FSH ratio was significantlyhigher than in women having a live birth. In conclusion, inPCOS patients stimulated with HMG, a high basal LH:FSH ratioappears to have an adverse effect on the number of folliclesand oocytes, as well as on oocyte maturity. On the other hand,the administration of GnRHa in the long protocol seems to reversethis detrimental effect on follicle and oocyte development.Furthermore, a higher LH:FSH ratio seems to predict a greaterpossibility for miscarriage, despite the use of GnRHa.