What is the Best Treatment for Women with Polycystic Ovarian Syndrome and High LH/FSH Ratio? A Comparison Among in Vitro Fertilization with GnRH Agonist, GnRH Antagonist and in Vitro Maturation

Overview

Journal J Endocrinol Invest

Publisher Springer

Specialty Endocrinology

Date 2016 Jan 23

PMID 26797707

Citations 6

Authors

Y Ganor-Paz

Y Friedler-Mashiach

Y Ghetler

A Hershko-Klement

A Berkovitz

O Gonen

A Shulman

A Wiser

Affiliations

Soon will be listed here.

Abstract

Purpose: To evaluate whether high LH/FSH ratio has a clinical impact on patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) with GnRH-agonist/antagonist protocols or in vitro maturation (IVM) treatments.

Methods: We retrospectively reviewed all PCOS patients with day 3 LH/FSH ratio ≥1.5 who underwent IVF or IVM. The main outcomes measures were embryo quality and pregnancy rate.

Results: A total of 75 cycles were included. Among these, 44 patients underwent long agonist protocol, 16 antagonist protocol and 15 IVM. Age, basal LH and FSH levels, as well as duration of infertility were comparable for all groups. The LH level on the day of hCG administration was significantly lower in the antagonist group (0.9 IU/ml) compared to the long agonist group (1.4 IU/ml, p = 0.01). There was no difference in pregnancy rates among the groups: 27.2 % in the long agonist group, 37.5 % in the antagonist group and 26.6 % among the IVM patients.

Conclusions: High LH/FSH ratio had no adverse effect on pregnancy rates in all three treatment modes.

Citing Articles

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Singh N, Mishra N, Dogra Y J Hum Reprod Sci. 2021; 14(1):21-27.

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References

Balen A, Tan S, MacDougall J, Jacobs H . Miscarriage rates following in-vitro fertilization are increased in women with polycystic ovaries and reduced by pituitary desensitization with buserelin. Hum Reprod. 1993; 8(6):959-64. DOI: 10.1093/oxfordjournals.humrep.a138174. View

Tarlatzis B, Grimbizis G, Pournaropoulos F, Bontis J, Lagos S, Spanos E . The prognostic value of basal luteinizing hormone:follicle-stimulating hormone ratio in the treatment of patients with polycystic ovarian syndrome by assisted reproduction techniques. Hum Reprod. 1995; 10(10):2545-9. DOI: 10.1093/oxfordjournals.humrep.a135742. View

Choi M, Lee S, Kim H, Cha S, Kim J, Yang K . Comparison of assisted reproductive technology outcomes in infertile women with polycystic ovary syndrome: In vitro maturation, GnRH agonist, and GnRH antagonist cycles. Clin Exp Reprod Med. 2013; 39(4):166-71. PMC: 3548075. DOI: 10.5653/cerm.2012.39.4.166. View

. Comparable clinical outcome using the GnRH antagonist ganirelix or a long protocol of the GnRH agonist triptorelin for the prevention of premature LH surges in women undergoing ovarian stimulation. Hum Reprod. 2001; 16(4):644-51. DOI: 10.1093/humrep/16.4.644. View

Waldstreicher J, Santoro N, Hall J, Filicori M, Crowley Jr W . Hyperfunction of the hypothalamic-pituitary axis in women with polycystic ovarian disease: indirect evidence for partial gonadotroph desensitization. J Clin Endocrinol Metab. 1988; 66(1):165-72. DOI: 10.1210/jcem-66-1-165. View

Mendoza C, Ruiz-Requena E, Ortega E, Cremades N, Martinez F, Bernabeu R . Follicular fluid markers of oocyte developmental potential. Hum Reprod. 2002; 17(4):1017-22. DOI: 10.1093/humrep/17.4.1017. View

Taylor A, McCourt B, Martin K, Anderson E, Adams J, Schoenfeld D . Determinants of abnormal gonadotropin secretion in clinically defined women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1997; 82(7):2248-56. DOI: 10.1210/jcem.82.7.4105. View

Child T, Phillips S, Gulekli B, Tan S . A comparison of in vitro maturation and in vitro fertilization for women with polycystic ovaries. Obstet Gynecol. 2002; 100(4):665-70. DOI: 10.1016/s0029-7844(02)02193-2. View

Tarlatzis B, Fauser B, Kolibianakis E, Diedrich K, Rombauts L, Devroey P . GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update. 2006; 12(4):333-40. DOI: 10.1093/humupd/dml001. View

10.

Gordon U, Harrison R, Fawzy M, Hennelly B, Gordon A . A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril. 2001; 75(2):324-31. DOI: 10.1016/s0015-0282(00)01701-5. View

11.

. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008; 89(3):505-22. DOI: 10.1016/j.fertnstert.2007.09.041. View

12.

Wiser A, Shehata F, Holzer H, Hyman J, Shalom-Paz E, Son W . Effect of high LH/FSH ratio on women with polycystic ovary syndrome undergoing in vitro maturation treatment. J Reprod Med. 2013; 58(5-6):219-23. View

13.

. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81(1):19-25. DOI: 10.1016/j.fertnstert.2003.10.004. View

14.

Al-Inany H, Youssef M, Aboulghar M, Broekmans F, Sterrenburg M, Smit J . Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev. 2011; (5):CD001750. DOI: 10.1002/14651858.CD001750.pub3. View

15.

Orvieto R, Meltcer S, Liberty G, Rabinson J, Anteby E, Nahum R . Does day-3 LH/FSH ratio influence in vitro fertilization outcome in PCOS patients undergoing controlled ovarian hyperstimulation with different GnRH-analogue?. Gynecol Endocrinol. 2012; 28(6):422-4. DOI: 10.3109/09513590.2011.633661. View

16.

Kolibianakis E, Zikopoulos K, Schiettecatte J, Smitz J, Tournaye H, Camus M . Profound LH suppression after GnRH antagonist administration is associated with a significantly higher ongoing pregnancy rate in IVF. Hum Reprod. 2004; 19(11):2490-6. DOI: 10.1093/humrep/deh471. View