THE PROGNOSTIC VALUE OF BASAL LUTEINIZING-HORMONE - FOLLICLE-STIMULATING-HORMONE RATIO IN THE TREATMENT OF PATIENTS WITH POLYCYSTIC OVARIANSYNDROME BY ASSISTED REPRODUCTION TECHNIQUES

One of the main endocrinological disturbances in patients with polycys tic ovarian syndrome (PCOS) is the increased baseline concentrations o f luteinizing hormone (LH) and consequently a high LH:follicle-stimula ting hormone (FSH) ratio. The aim of this study was to assess the rela tionship between the baseline LH:FSH ratio with the stimulation respon se and the miscarriage risk in PCOS women stimulated for assisted repr oduction techniques (ART) with and without gonadotrophin-releasing hor mone analogue (GnRHa). Two groups of PCOS patients were analysed retro spectively. Group A (n = 20, 20 cycles) consisted of women stimulated with human menopausal gonadotrophin (HMG), and group B (n = 128, 162 c ycles) comprised women stimulated with buserelin-long/HMG. LH and FSH concentrations were measured during the early follicular phase (days 4 -6) in a preceding spontaneous or progestin-induced cycle, The followi ng parameters were assessed: number of follicles developed, number of oocytes obtained and percentage of mature oocytes, as well as number o f abortions and live births. In group A, the baseline LH:FSH ratio was correlated inversely with the number of follicles developed (P < 0.05 ), the number of oocytes obtained (P < 0.05) and the percentage of mat ure oocytes (P < 0.05). In group B, no correlation was found between t he LH:FSH ratio and the number of follicles and oocytes, because their numbers were relatively constant irrespective of the baseline LH:FSH ratio, but a significant inverse correlation was noted with the percen tage of mature oocytes (P < 0.001). However, a comparison of the slope s of the curve indicated a better correlation between the LB:FSH ratio and the percentage of mature oocytes in group A than in group B (P ( 0.05). These findings were also confirmed when patients were subdivide d according to the LH:FSH ratio (<3 or greater than or equal to 3). Fu rthermore, in women who miscarried, the mean LH:FSH ratio was signific antly higher than in women having a live birth. In conclusion, in PCOS patients stimulated with HMG, a high basal LH:FSH ratio appears to ha ve an adverse effect on the number of follicles and oocytes, as well a s on oocyte maturity. On the other hand, the administration of GnRHa i n the long protocol seems to reverse this detrimental effect on follic le and oocyte development. Furthermore, a higher LH:FSH ratio seems to predict a greater possibility for miscarriage, despite the use of GnR Ha.