Early Follicular Phase LH concentration and LH to FSH ratio as Predictor of IVF/ICSI Outcome.

Background: This study was undertaken to evaluate the effect of early follicular phase LH level and LH: FSH ratio on number of mature follicles, retrieved oocytes, oocytes maturity, quality of embryo, and pregnancy rate. Methods: This retrospective observational study was undertaken in the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies /Al-Nahrain University. The study included 115 women who underwent IVF/ICSI treatment cycles from February 2015 to may 2016. Prior to the first IVF/ICSI treatment all women included in the study had blood samples analyzed on menstrual cycle Day 2, 3 or 4 for basal levels of Follicle stimulating hormone and Luteinizing hormone. Patients was sub grouped according to early follicular phase LH to FSH ratio into group A ?0.5 and group B>0.5, and regarding early follicular phase LH into Group I (?3 mIU/ml) and Group II (>3 mIU/ml) Results: Women with elevated early follicular phase LH to FSH ratio (LH: FSH>0.5) required significantly (p<0.001) lower doses of gonadotrophins. The outcome of IVF/ICSI was significantly (p<0.001) better in those patients they had larger number of mature follicles (?17mm), retrieved oocytes, mature oocytes (metaphase II), fertilized oocytes, cleaved embryos, and pregnancy rates. On the other hand, patients with early follicular phase LH >3 mIU/ml did not differ significantly than patients with early follicular phase (?3 mIU/ml). Conclusion: Elevated early follicular phase LH/FSH ratio rather than LH concentration alone is associated with the highest success rates in IVF/ICSI, perhaps reflecting a well-preserved ovarian reserve.