Research On The Relationship Between FSH/LH Ratio After Pituitary Down-regulation And IVF/ICSI-ET Outcome

Objective: This article aims to research the relationship between serumfollicular stimulating hormone (FSH)/luteotropic hormone (LH) ratio afterpituitary down-regulation and in vitro fertilization and embryotransfer/intracytoplasmic sperm injection and embryo transplantation(IVF/ICSI-ET) outcome in controlled ovarian stimulation (COS). And it aimsto compare the relationship between FSH/LH ratio after pituitarydown-regulation and IVF/ICSI-ET outcome in different crowd and in patientswith different daily pituitary down-regulation doses.Methods: A retrospective analysis was conducted in2667cycles whoGnRHa protocol was firstly applied in our center from January2012toOctober2013. The patients were divided into five groups separately accordingto the FSH/LH ratio after pituitary down-regulation, one group with FSH/LHratio after pituitary down-regulation≤1(Group A1), one group with1<FSH/LH ratio after pituitary down-regulation≤2(Group A2), one groupwith2<FSH/LH ratio after pituitary down-regulation≤3(Group A3), onegroup with3<FSH/LH ratio after pituitary down-regulation≤4(Group A4) andone group with FSH/LH ratio after pituitary down-regulation>5(Group A5).We compared the age, duration of infertility, distribution of infertility types,the rate of IVF and ICSI, the basal hormone level, the dosage and duration ofgonadotrophin (Gn), number of retrieved oocytes, number of transferableembryos, number of2PN embryos, number of cleavage, number of goodquality embryos, fertilization rate, cleavage rate, clinical pregnancy rate andfrozen embryo rate. We divided patients with the daily short-acting Decapepthldose of0.1mg/day in luteal phase as Group B. Then Group B was split intofive groups separately according to the FSH/LH ratio after pituitarydown-regulation, one group with FSH/LH ratio after pituitary down-regulation ≤1(Group B1), one group with1<FSH/LH ratio after pituitarydown-regulation≤2(Group B2), one group with2<FSH/LH ratio afterpituitary down-regulation≤3(Group B3), one group with3<FSH/LH ratioafter pituitary down-regulation≤4(Group B4) and one group with FSH/LHratio after pituitary down-regulation>5(Group B5). We compared the numberof retrieved oocytes and other data between these five groups. We dividedpatients with daily short-acting Decapepthl dose of0.05mg/day in luteal phaseas group C. Then Group C was split into five groups separately according tothe FSH/LH ratio after pituitary down-regulation, one group with FSH/LHratio after pituitary down-regulation≤1(Group C1), one group with1<FSH/LH ratio after pituitary down-regulation≤2(Group C2), one groupwith2<FSH/LH ratio after pituitary down-regulation≤3(Group C3), onegroup with3<FSH/LH ratio after pituitary down-regulation≤4(Group C4) andone group with FSH/LH ratio after pituitary down-regulation>5(Group C5).We compared the number of retrieved oocytes and other data between thesefive groups. We divided patients with Polycystic Ovary Syndrome (PCOS)who used oral contraceptives (OC) and Decapepthl double pressure scheme asgroup D. Because of the limitation of simple size, we split group D into threegroups, one group with FSH/LH ratio after pituitary down-regulation≤1(Group D1), one group with1<FSH/LH ratio after pituitarydown-regulation≤2(Group D2), one group with2<FSH/LH ratio afterpituitary down-regulation>3(Group D3), and compared the number ofretrieved oocytes and other data between these three groups.Results:Group A: There was no significant difference in patients’ duration ofinfertility, the rate of IVF and ICSI, basal FSH levels, basal E2levels, thedosage of HMG, fertilization rate, good quality embryos rate and clinicalpregnancy rate between Group A1, Group A2, Group A3, Group A4andGroup A5(P>0.05). We found that FSH/LH ratio after pituitarydown-regulation was positively related to patients’ age (r=0.116, P<0.001).The distribution of infertility types had significant difference (χ2=21.40, P<0. 001). The proportion of primary infertility in Group A5was the lowest. Thedosage of Gn and FSH had significant difference (H=10.14, P<0.05; H=15.33,P<0.01). The dosage of Gn and FSH in Group A3is lower while the dosage ofGn and FSH in Group A1is higher. We found that FSH/LH ratio after pituitarydown-regulation was negatively related to basal LH level, duration of Gn,number of retrieved oocytes, number of transferable embryos, number of2PNembryos, number of cleavage, and number of good quality embryos (r=-0.253,P<0.001; r=-0.130, P<0.001; r=-0.223, P<0.001; r=-0.157, P<0.001; r=-0.194,P<0.001; r=-0.201, P<0.001; r=-0.095, P<0.001). There was significantdifference in patients’ frozen embryo rate (χ2=72.74, P<0.001). The frozenembryo rate in Group A1is highest while the frozen embryo rate in Group A5is lowest.Group B: There was no significant difference in patients’ duration ofinfertility, the rate of IVF and ICSI, basal FSH levels, basal E2levels, ages,duration of Gn, the dosage of Gn, FSH, HMG, fertilization rate, good qualityembryos rate and clinical pregnancy rate between Group B1, Group B2, GroupB3, Group B4and Group B5(P>0.05). The distribution of infertility types hadsignificant difference (χ2=10.31, P<0.05). The proportion of primary infertilityin Group B5was the lowest. We found that FSH/LH ratio after pituitarydown-regulation was negatively related to basal LH level, duration of Gn,number of retrieved oocytes, number of transferable embryos, number of2PNembryos, number of cleavage and number of good quality embryos (r=-0.312,P<0.001; r=-0.209, P<0.001; r=-0.195, P<0.001; r=-0.127, P<0.001; r=-0.157,P<0.001; r=-0.163, P<0.001; r=-0.092, P<0.01). There was significantdifference in patients’ frozen embryo rate (χ2=26.77, P<0.001). The frozenembryo rate in Group B1is highest while the frozen embryo rate in Group B5is lowest.Group C: There was no significant difference in patients’ duration ofinfertility, the rate of IVF and ICSI, the distribution of infertility types, basalFSH levels, basal E2levels, duration of Gn, the dosage of Gn, FSH, HMG,fertilization rate, good quality embryos rate and clinical pregnancy rate between Group C1, Group C2, Group C3, Group C4and Group C5(P>0.05).We found that FSH/LH ratio after pituitary down-regulation was positivelyrelated to patients’ age (r=0.143, P<0.001), while being negatively related tobasal LH level, number of retrieved oocytes, number of transferable embryos,number of2PN embryos, number of cleavage and number of good qualityembryos (r=-0.236, P<0.001; r=-0.180, P<0.001; r=-0.141, P<0.001; r=-0.151,P<0.001; r=-0.161, P<0.001; r=-0.070, P<0.01). There was significantdifference in patients’ frozen embryo rate (χ2=25.85, P<0.001). The frozenembryo rate in Group C1is highest while the frozen embryo rate in Group C5is lowest.Group D: There was no significant difference in patients’ ages, durationof infertility, the rate of IVF and ICSI, the distribution of infertility types,basal FSH levels, basal E2levels, duration of Gn, the dosage of Gn, FSH,HMG, number of transferable embryos, number of2PN embryos, number ofgood quality embryos, fertilization rate, good quality embryos rate, clinicalpregnancy rate and frozen embryo rate between Group D1, Group D2andGroup D3(P>0.05). We found that FSH/LH ratio after pituitarydown-regulation was negatively related to basal LH level, number of retrievedoocytes and number of cleavage (r=-0.170, P<0.05; r=-0.187, P<0.01;r=-0.175, P<0.05).Conclusions: Except for PCOS patients，no matter how much the dailydose of short-acting Decapepthl is, the FSH/LH ratio after pituitarydown-regulation can predict number of retrieved oocytes, number oftransferable embryos, number of2PN embryos, number of cleavage, numberof good quality embryos and the frozen embryo rate. But it can not predictfertilization rate, good quality embryos rate and clinical pregnancy rate. TheFSH/LH ratio after pituitary down-regulation was negatively related to basalLH level, duration of Gn, number of retrieved oocytes, number of transferableembryos, number of2PN embryos, number of cleavage, and number of goodquality embryos. When the FSH/LH ratio after pituitary down-regulation ishigher, the frozen embryo rate is lower. However, the FSH/LH ratio after pituitary down-regulation can onlypredict number of retrieved oocytes and number of cleavage in PCOS patients.The FSH/LH ratio after pituitary down-regulation was negatively related tothe number of retrieved oocytes and the number of cleavage.