Derya DEVECİ, Sevim TUNCER CAN, Zehra Sema ÖZKAN, Özgür ARAT

What is the effect of the early follicular phase FSH/LH ratio on the number of mature oocytes and embryo development?

Background/aim: Basal level of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and antral follicle countare used as predictors of ovarian reserve before starting ovulation induction. We aimed to investigate the predictor potential of earlyfollicular phase FSH/LH ratio on controlled ovarian hyperstimulation-intracytoplasmic sperm injection (COH-ICSI) cycle outcomes.Materials and methods: This retrospective cohort study was conducted with 648 COH-ICSI cycles performed between 2012 and 2014.Cycles were classified according to their basal FSH/LH ratio, group 1(G1) = FSH/LH ratio < 2, N = 473 and group 2(G2) = FSH/LHratio ≥ 2, N = 175. Demographic characteristics and stimulation parameters were evaluated. Retrieved total oocyte count (TOC), matureoocyte count (MOC), transferred embryo number, and pregnancy results were obtained and transferred to computer by SPSS 21.0programme.Results: TOC and MOC of G1 were significantly higher than those of G2. The total gonadotrophin doses of G2 were significantly higherthan G1. There was no significant difference between groups for transferred embryo number. Pregnancy and live birth rates were similarin both groups.Conclusion: In our population, increased FSH/LH ratio did not affect the rates of pregnancy and live birth negatively.

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1. Barroso G, Oehninger S, Monzó A, Kolm P, Gibbons WE et al. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. Journal of Assisted Reproduction and Genetics 2001;18 (9): 499-505. doi: 10.1023/a:1016601110424
2. Chalumeau C, Moreau J, Gatimel N, Cohade C, Lesourd F et al. Establishment and validation of a score to predict ovarian response to stimulation in IVF. Reproductive Biomedicine Online 2018; 36 (1): 26-31. doi: 10.1016/j.rbmo.2017.09.011
3. Rehman R, Syed H, Iqbal NT, Arif S, Sheharyar S. FSH/LH ratio in females and intracytoplasmic sperm injection. Journal of Pakistan Medical Association 2015; 65 (12): 1330-1333.
4. Alborzi S, Madadi G, Samsami A, Soheil P, Azizi M et al. Decreased ovarian reserve: any new hope? Minerva Ginecologica 2015; 67 (2): 149-167.
5. Shrim A, Elizur SE, Seidman DS, Rabinovici J, Wiser A et al. Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response. Reproductive Biomedicine Online 2006; 12 (4): 418-422.
6. Kofinas JD, Elias RT. Follicle-stimulating hormone/luteinizing hormone ratio as an independent predictor of response to controlled ovarian stimulation. Womens Health (Lond) 2014; 10 (5): 505-509. doi: 10.2217/whe.14.31
7. Prasad S, Gupta T, Divya A. Correlation of the Day 3 FSH/ LH Ratio and LH Concentration in Predicting IVF Outcome. Journal of Reproduction and Infertility 2013; 14 (1): 23-28.
8. Lyu SW, Kim JW, Choi CH, Seok HH, Yoon TK et al. Impact of high basal FSH/LH ratio in women with normal FSH levels on in vitro fertilization outcomes. Gynecological Endocrinology 2013; 29 (5): 424-429.
9. Gürbüz B, Yalti S, Ozden S, Ficicioglu C. High basal estradiol level and FSH/LH ratio in unexplained recurrent pregnancy loss. Archieves of Gynecology and Obstetrics 2004; 270 (1): 37- 39. doi: 10.1007/s00404-003-0490-0
10. Özkan ZS. Ovarian stimulation modalities in poor responders. Turkish Journal of Medical Sciences 2019; 49 (4): 959-962. doi: 10.3906/sag-1905-179
11. Poseidon Group (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number), Alviggi C, Andersen CY, Buehler K, Conforti A et al. A new more detailed stratification of low responders to ovarian stimulation: from a poor ovarianresponse to a low prognosis concept. Fertility and Sterility 2016; 105 (6): 1452-1453. doi: 10.1016/j.fertnstert.2016.02.005
12. Humaidan P,Alviggi C,Fischer R,Esteves SC. The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome. F1000Research 2016; 5: 2911. doi: 10.12688/ f1000research.10382.1
13. Alviggi C, Conforti A, Esteves SC, Vallone R, Venturella R et al. Understanding ovarian hypo-response to exogenous gonadotropin in ovarian stimulation and its new proposed marker-the follicleto- oocyte (FOI) index. Frontiers in Endocrinology (Lausanne) 2018; 9: 589. doi: 10.3389/fendo.2018.00589
14. Scheinhardt MO, Lerman T, König IR, Griesinger G. Performance of prognostic modelling of high and low ovarian responseto ovarian stimulation for IVF. Human Reproduction 2018; 33 (8): 1499-1505. doi: 10.1093/humrep/dey236
15. Khan HL, Bhatti S, Suhail S, Gul R, Awais A et al. Antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) are the predictors of natural fecundability have similar trends irrespective of fertility status and menstrual characteristics among fertile and infertile women below the age of 40 years. Reproductive Biology and Endocrinology 2019; 17 (1): 20. doi: 10.1186/s12958-019-0464-0
16. Zhen XM, Qiao J, Li R, Wang LN, Liu P. The clinical analysis of poor ovarian response in in-vitro-fertilization embryo-transfer among Chinese couples. Journal of Assisted Reproduction and Genetics 2008; 25 (1): 17-22. doi: 10.1007/s10815-007-9187-9
17. Ho JY, Guu HF, Yi YC, Chen MJ, Ho ES. The serum folliclestimulating hormone-to-luteinizing hormone ratio at the start of stimulation with gonadotropins after pituitary downregulation is inversely correlated with a mature oocyte yield and can predict “low responders”. Fertility and Sterility 2005; 83 (4): 883-888. doi: 10.1016/j.fertnstert.2004.10.040
18. Johnson NP, Bagrie EM, Coomarasamy A, Bhattacharya S, Shelling AN et al. Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review of ovarian reserve test accuracy. BJOG An International Journal of Obstetrics and Gynaecology 2006; 113 (12): 1472-1480. doi: 10.1111/j.1471- 0528.2006.01068.x
19. Liang X, Zhuang G, Zhou C. The predication of ovarian response in control ovarian hyperstimulation by the ratio of basal FSH and LH level. Zhonghua Yi Xue Za Zhi 2001; 81 (13): 819-821.
20. Mukherjee T, Copperman AB, Lapinski R, Sandler B, Bustillo M et al. 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. Fertility and Sterility 1996; 65 (3): 588-593. doi: 10.1016/s0015-0282(16)58159-x
21. 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. Fertility and Sterility 2008; 90 (2): 297-301. doi:10.1016/j.fertnstert.2007.06.038
22. Huang Y, Li J, Zhang F, Liu Y, Xu G et al. Factors affecting the live-birth rate in women with diminished ovarian reserve undergoing IVF-ET. Archieves of Gynecology and Obstetrics 2018; 298 (5): 1017-1027. doi: 10.1007/s00404-018-4884-4
23. Polyzos NP, Drakopoulos P, Parra J, Pellicer A, Santos-Ribeiro S et al. Cumulative live birth rates according to the number of oocytes retrieved after the first ovarian stimulation for in vitro fertilization/intracytoplasmic sperm injection: a multicenter multinational analysis including ∼15,000 women. Fertility and Sterility 2018; 110 (4): 661-670.e1. doi: 10.1016/j. fertnstert.2018.04.039.
24. Li Z, Wang AY, Bowman M, Hammarberg K, Farquhar C et al. ICSI does not increase the cumulative live birth rate in non-male factor infertility. Human Reproduction 2018; 33 (7): 1322-1330. doi: 10.1093/humrep/dey118
25. Rao M, Zeng Z, Tang L. Maternal physical activity before IVF/ ICSI cycles improves clinical pregnancy rate and live birth rate: a systematic review and meta-analysis. Reproductive Biology and Endocrinology 2018; 16 (1): 11. doi: 10.1186/s12958-018- 0328-z
26. Orvieto R, Homburg R, Meltcer S, Rabinson J, Anteby EY et al. HMG improves IVF outcome in patients with high basal FSH/LH ratio: a preliminary study. Reproductive Biomedicine Online 2009; 18 (2): 205-208. doi: 10.1016/s1472- 6483(10)60257-x