Elevated day 3 follicle-stimulating hormone/luteinizing hormone ratio ≥ 2 is associated with higher rates of cancellation in in vitro fertilization-embryo transfer cycles

ObjectiveTo evaluate the day 3 FSH/LH ratio as a predictor of prognosis in IVF cycles.DesignA retrospective cohort study.SettingAn academic hospital-based fertility center.Patient(s)Two hundred ninety-seven women younger than 40 years old with day 3 FSH levels ≤10 IU/L undergoing their first IVF cycle.Intervention(s)A retrospective chart review of patients undergoing their first cycle of IVF was performed. We compared cycle characteristics and outcomes in women with normal FSH/LH ratios and those with elevated FSH/LH ratios (≥2).Main Outcome Measure(s)Pregnancy and cancellation rates.Result(s)One-third of patients had a day 3 FSH/LH ratio ≥2.0. Patients with an elevated FSH/LH ratio were more likely to have been placed on an aggressive protocol and had higher starting (257 vs. 232 IU) and total (2484 vs. 2136 IU) FSH doses. Patients with an elevated FSH/LH ratio were more likely to have their cycles cancelled before retrieval (19.6% vs. 8.5%). Although there was a trend toward lower pregnancy rates (24.7% vs. 33.5%), this result was not statistically significant. No clinical pregnancies occurred in 16 women with an FSH/LH ratio ≥3.5.Conclusion(s)An increased FSH/LH ratio of ≥2.0 was associated with poorer IVF cycle outcomes and higher rates of cycle cancellation.