The serum follicle-stimulating hormone-to-luteinizing hormone ratio at the start of stimulation with gonadotropins after pituitary down-regulation is inversely correlated with a mature oocyte yield and can predict "low responders".

OBJECTIVE

The aim of this study was to investigate the relationship of serum FSH and LH levels at the commencement of stimulation to ovarian follicular development in women undergoing pituitary down-regulation and controlled ovarian hyperstimulation with gonadotropins in IVF or intracytoplasmic sperm injection (ICSI) cycles.

DESIGN

Retrospective analysis.

SETTING

An IVF program in a tertiary medical center.

PATIENT(S): A total of 245 women proven to be pituitary down-regulated by their serum E(2) levels.

INTERVENTION(S): Patients treated with a GnRH agonist and FSH and hMG underwent assisted reproductive technique (ART).

MAIN OUTCOME MEASURE(S): Mature oocyte yield, pregnancy rate (PR), and live birth rate.

RESULT(S): The serum FSH levels and the FSH-to-LH ratio at the commencement of gonadotropin stimulation were inversely correlated to the number of mature oocytes (r = -0.193 and r = -0.224, respectively). When assessed with receiver-operating characteristic (ROC) analysis, there was statistically significant ability for the FSH/LH ratio to differentiate between the "poor response" cycles (with mature oocyte yield < or =4) and the normal response cycles. Using the cutoff value derived from ROC analysis, cycles with the FSH-to-LH ratio > or =3 produced less mature oocytes (8.25 vs. 11.74), lower peak E(2) levels (1,975.3 pg/mL vs. 3,324.8 pg/mL), and higher percentage of poor ovarian response cycles (32.5% vs. 14.3%).

CONCLUSION(S): The serum FSH-to-LH ratio at the start of gonadotropin stimulation after pituitary down-regulation provided a practical method for early prediction of mature oocyte yield.