Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Endocrinol (Lausanne). 2023 Jan 30;14:1093954. doi: 10.3389/fendo.2023.1093954. eCollection 2023.
The basal follicle stimulating hormone (FSH)/luteinizing hormone (LH) ratio is a useful predictor of ovarian response. In this study, we investigated whether the FSH/LH ratios during the entire controlled ovarian stimulation (COS) can be used as effective predictors of outcomes in women undergoing fertilization (IVF) treatment using the gonadotropin releasing hormone antagonist (GnRH-ant) protocol.
A total of 1,681 women undergoing their first GnRH-ant protocol were enrolled in this retrospective cohort study. A Poisson regression model was used to analyze the association between the FSH/LH ratios during COS and embryological outcomes. Receiver operating characteristic analysis was performed to determine the optimal cutoff values for poor responders (≤ 5 oocytes) or poor reproductive potential (≤ 3 available embryos). A nomogram model was constructed to provide a tool for predicting the cycle outcomes of individual IVF treatments.
The FSH/LH ratios (at the basal day, stimulation day 6 (SD6) and trigger day) were significantly correlated with the embryological outcomes. The basal FSH/LH ratio was the most reliable predictor of poor responders with a cutoff value of 1.875 (area under the curve (AUC) = 72.3%, < 0.05), or of poor reproductive potential with a cutoff value of 2.515 (AUC = 66.3%, < 0.05). The SD6 FSH/LH ratio predicted poor reproductive potential with a cutoff value of 4.14 (AUC = 63.8%, < 0.05). The trigger day FSH/LH ratio predicted poor responders with a cutoff value of 9.665 (AUC = 63.1%, < 0.05). The basal FSH/LH ratio, combined with the SD6 and trigger day FSH/LH ratios, slightly increased these AUC values and improved the prediction sensitivity. The nomogram provides a reliable model with which to assess the risk of poor response or poor reproductive potential directly based on the combined indicators.
FSH/LH ratios are useful predictors of poor ovarian response or reproductive potential throughout the entire COS with the GnRH antagonist protocol. Our findings also provide insights into the potential for LH supplementation and regimen adjustment during COS to achieve improved outcomes.
基础卵泡刺激素（FSH）/黄体生成素（LH）比值是预测卵巢反应的有用指标。在这项研究中，我们探讨了在使用促性腺激素释放激素拮抗剂（GnRH-ant）方案进行体外受精（IVF）治疗时，整个控制性卵巢刺激（COS）期间的 FSH/LH 比值是否可作为结局的有效预测指标。
本回顾性队列研究纳入了 1681 名首次接受 GnRH-ant 方案的女性。采用泊松回归模型分析 COS 期间 FSH/LH 比值与胚胎学结局之间的关系。进行受试者工作特征（ROC）分析以确定不良反应者（≤5 个卵母细胞）或不良生殖潜能（≤3 个可利用胚胎）的最佳截断值。构建列线图模型以提供预测个体 IVF 治疗周期结局的工具。
FSH/LH 比值（基础日、刺激第 6 天（SD6）和扳机日）与胚胎学结局显著相关。基础 FSH/LH 比值是预测不良反应者的最可靠指标，截断值为 1.875（曲线下面积（AUC）=72.3%，<0.05），或预测不良生殖潜能的截断值为 2.515（AUC=66.3%，<0.05）。SD6 FSH/LH 比值预测不良生殖潜能的截断值为 4.14（AUC=63.8%，<0.05）。扳机日 FSH/LH 比值预测不良反应者的截断值为 9.665（AUC=63.1%，<0.05）。基础 FSH/LH 比值与 SD6 和扳机日 FSH/LH 比值相结合，略微提高了这些 AUC 值并提高了预测敏感性。列线图提供了一个可靠的模型，可以根据联合指标直接评估不良反应或不良生殖潜能的风险。
在 GnRH-ant 方案的整个 COS 期间，FSH/LH 比值是预测卵巢反应不良或生殖潜能不良的有用指标。我们的研究结果还为在 COS 期间补充 LH 和调整方案以获得更好的结局提供了新的见解。
