A new study has added to the evidence suggesting that an elevated day 3 ratio of FSH to LH is associated with poorer outcomes of IVF and higher rates of cycle cancellation.

For their study, published in the current issue of the journal Fertility and Sterility, researchers from the Mount Sinai Hospital and the University of Toronto, Canada, conducted a retrospective review of the records of 297 women in order to evaluate the day 3 ratio of follicle-stimulating hormone (FSH) to luteinizing hormone (LH) as a predictor of the prognosis of IVF cycles. The women in the study were all less than 40 years of age, undergoing their first cycle of IVF, and had a normal day 3 basal FSH level, of 10 IU/L or less.

About one-third of the patients had an elevated day 3 FSH/LH ratio: 97 women had a ratio of 2.0 or more, while 200 had a ratio of less than 2.0.

Both groups of women were similar in age, gravidity, parity and diagnosis. However, the patients with an elevated ratio were significantly more likely to have been placed on an aggressive (microdose flare) protocol. They were also significantly more likely to have been started on a slightly higher starting dose of FSH (mean 257 IU versus 232 IU, respectively), and to have been given a higher total dose of FSH (mean 2484 IU versus 2136 IU, respectively).

Overall, the women with an elevated FSH/LH ratio had poorer cycle outcomes, including significantly fewer follicles (7.6 follicles 1.7cm or larger, compared with 8.9 in the non-elevated ratio group), significantly fewer oocytes (10 versus 13.2) and significantly fewer day 3 embryos of 6 cells or more (4.2 versus 5.6).

The researchers also found that the women with an elevated FSH/LH ratio were significantly more likely to have their cycles cancelled before retrieval: 19.6 percent of cycles were cancelled compared with only 8.5 percent of cycles in women with an FSH/LH ratio below 2.0.

There was a trend towards a lower rate of clinical pregnancy per cycle start in women with an elevated FSH/LH ratio (18.6 percent versus 25.5 percent) but this difference was not statistically significant.

In the discussion of their findings, the researchers note that the FSH/LH ratio showed the highest correlation with clinical pregnancy over the other measures of ovarian reserve that were investigated, including day 3 estradiol levels, ovarian volume, and antral follicle count.

The researchers conclude: “The day 3 FSH/LH ratio is a relatively easy test to obtain and adds more predictive power over the day 3 FSH level alone, especially in younger patients with a normal FSH level [less than or equal to 10 IU/L]. In particular, the unexpectedly high rate of cycle cancellation in this group as found in this study may aid in cycle planning and counseling.”

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