The association between FSH/LH ratio and ovulation induction outcomes in unexplain infertile patients
Öz
Aim: To evaluate the association between FSH/LH ratio and
assisted reproductive techniques treatment outcomes in patients with unexplained
infertility.
Material and Method: Sixty six unexplained infertile patient who underwent
ovarian stimulation and intrauterine insemination protocol were enrolled this
study. Risk factors evaluated were; age, BMI, infertility period, induction
period, total gonadotropin dosage, Estradiol level at HCG day, endometrial
thickness at HCG
day, basal FSH, LH, E2 levels, pregnancy rates and follicle count. Patients divided
in two groups whether FSH/LH ratio <2 (group 1, n=42) and ≥2 (group 2, n=24).
Result: The mean age of the study population was 26.71±1.01.
There was no statically significant difference between groups in terms of age,
BMI, FSH levels and pregnancy rate (p>0.05). Induction period, total
gonadotropin dosage, Estradiol level at HCG day, LH, E2 levels and follicle count were statically
significant between groups (p<0.05). There was a positive correlation
between FSH/LH ratio and total gonadotropin dosage, Estradiol level at HCG day, Estradiol level, induction
period and follicle count.
Conclusion: According to our results; increased basal FSH/LH ratio
associated with poor ovarian response in ART cycles.
Anahtar Kelimeler
Kaynakça
- 1. Roudebush, W.E., W.J. Kivens, and J.M. Mattke, Biomarkers of Ovarian Reserve. Biomark Insights, 2008. 3: p. 259-268. 2. Evers, J.L., Female subfertility. Lancet, 2002. 360(9327): p. 151-9. 3. Rouchou, B., Consequences of infertility in developing countries. Perspect Public Health, 2013. 133(3): p. 174-9. 4. Steures, P., et al., Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet, 2006. 368(9531): p. 216-21. 5. Scott, R.T., Jr. and G.E. Hofmann, Prognostic assessment of ovarian reserve. Fertil Steril, 1995. 63(1): p. 1-11. 6. Lee, S.J., et al., The effect of age on the cyclical patterns of plasma LH, FSH, oestradiol and progesterone in women with regular menstrual cycles. Hum Reprod, 1988. 3(7): p. 851-5. 7. Lenton, E.A., et al., Progressive changes in LH and FSH and LH: FSH ratio in women throughout reproductive life. Maturitas, 1988. 10(1): p. 35-43. 8. Orvieto, R., et al., Does day 3 luteinizing-hormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues? Fertil Steril, 2008. 90(4): p. 1297-300. 9. Insler, V., et al., Polycystic ovaries in non-obese and obese patients: possible pathophysiological mechanism based on new interpretation of facts and findings. Hum Reprod, 1993. 8(3): p. 379-84. 10. Pagan, Y.L., et al., Inverse relationship between luteinizing hormone and body mass index in polycystic ovarian syndrome: investigation of hypothalamic and pituitary contributions. J Clin Endocrinol Metab, 2006. 91(4): p. 1309-16. 11. Gordon, U.D., et al., A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril, 2001. 75(2): p. 324-31. 12. Carone, D., et al., Efficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols. J Endocrinol Invest, 2012. 35(11): p. 996-1002. 13. McClure, N., et al., Age and follicular phase estradiol are better predictors of pregnancy outcome than luteinizing hormone in menotropin ovulation induction for anovulatory polycystic ovarian syndrome. Fertil Steril, 1993. 59(4): p. 729-33. 14. Sharara, F.I., R.T. Scott, Jr., and D.B. Seifer, The detection of diminished ovarian reserve in infertile women. Am J Obstet Gynecol, 1998. 179(3 Pt 1): p. 804-12. 15. Tarlatzis, B.C., et al., Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update, 2003. 9(1): p. 61-76. 16. Barnhart, K. and J. Osheroff, Follicle stimulating hormone as a predictor of fertility. Curr Opin Obstet Gynecol, 1998. 10(3): p. 227-32. 17. Bukman, A. and M.J. Heineman, Ovarian reserve testing and the use of prognostic models in patients with subfertility. Hum Reprod Update, 2001. 7(6): p. 581-90. 18. Creus, M., et al., Day 3 serum inhibin B and FSH and age as predictors of assisted reproduction treatment outcome. Hum Reprod, 2000. 15(11): p. 2341-6. 19. Mukherjee, T., et al., An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. Fertil Steril, 1996. 65(3): p. 588-93. 20. Barroso, G., et al., High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet, 2001. 18(9): p. 499-505. 21. Shrim, A., et al., Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response. Reprod Biomed Online, 2006. 12(4): p. 418-22.
Gonadotropin ile ovülasyon indüksiyonu yapılan açıklanamayan infertil olgularda FSH/LH oranının rolü
Öz
Amaç:
FSH/LH oranının gonadotropin ile yapılan kontrollü ovulasyon indüksiyonu
sikluslarının sonuçları üzerindeki etkisini araştırmak.
Gereç
ve Yöntem: Çalışmaya kliniğimizde açıklanamayan
infertilite tanısı ile takip edilen ve gonadotropin ile kontrollü ovarian
hiperstimulasyon, devamında intrauterin inseminasyon (IUI) yapılan 66 hasta
dahil edildi. Hastaların yaş, BMI, infertilite süresi, indüksiyon için
kullanılan total gonadotropin dozu, HCG günü estradiol (E2) düzeyi, HCG günü
endometrium kalınlığı, bazal FSH, LH, E2 düzeyleri, indüksiyon süresi, gebelik
oluşumu ve gelişen folikül sayısı gibi demografik ve klinik değişkenleri
kaydedildi. Hastalar FSH/LH oranı 2’nin altında olanlar (grup 1, n=42); 2 ve
üzerinde olanlar (grup 2, n=24) olacak şekilde iki gruba ayrıldı. Gruplar
belirtilen değişkenler açısından istatistiksel olarak karşılaştırıldı.
Bulgular:
Çalışmaya dahil edilen 66 hastanın ortalama yaşı 26.71±1.01 idi. Gruplar
arasında yaş, BMI, FSH düzeyi, HCG günü bakılan endometrium kalınlığı gebelik
sayıları açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). HCG günü
bakılan estradiol seviyesi, LH düzeyi, folikül sayısı FSH/LH oranı düşük olan
grupta anlamlı yüksek; total gonadotropin dozu, bazal estradiol düzeyi,
indüksiyon süresi ise istatistiksel olarak anlamlı düşük idi (p<0.05).
FSH/LH oranı ile HCG günü estradiol düzeyi, total gonadotropin dozu, estradiol
düzeyi, indüksiyon süresi ve folikül sayısı arasında pozitif korelasyon vardı.
Sonuç:
Çalışmamızın
sonuçlarına göre; artmış bazal FSH/LH oranı, açıklanamayan infertilite
nedeniyle ovulasyon indüksiyonu yapılan hastalarda kötü over cevabı ile
ilişkilidir
Anahtar Kelimeler
Kaynakça
- 1. Roudebush, W.E., W.J. Kivens, and J.M. Mattke, Biomarkers of Ovarian Reserve. Biomark Insights, 2008. 3: p. 259-268. 2. Evers, J.L., Female subfertility. Lancet, 2002. 360(9327): p. 151-9. 3. Rouchou, B., Consequences of infertility in developing countries. Perspect Public Health, 2013. 133(3): p. 174-9. 4. Steures, P., et al., Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet, 2006. 368(9531): p. 216-21. 5. Scott, R.T., Jr. and G.E. Hofmann, Prognostic assessment of ovarian reserve. Fertil Steril, 1995. 63(1): p. 1-11. 6. Lee, S.J., et al., The effect of age on the cyclical patterns of plasma LH, FSH, oestradiol and progesterone in women with regular menstrual cycles. Hum Reprod, 1988. 3(7): p. 851-5. 7. Lenton, E.A., et al., Progressive changes in LH and FSH and LH: FSH ratio in women throughout reproductive life. Maturitas, 1988. 10(1): p. 35-43. 8. Orvieto, R., et al., Does day 3 luteinizing-hormone level predict IVF success in patients undergoing controlled ovarian stimulation with GnRH analogues? Fertil Steril, 2008. 90(4): p. 1297-300. 9. Insler, V., et al., Polycystic ovaries in non-obese and obese patients: possible pathophysiological mechanism based on new interpretation of facts and findings. Hum Reprod, 1993. 8(3): p. 379-84. 10. Pagan, Y.L., et al., Inverse relationship between luteinizing hormone and body mass index in polycystic ovarian syndrome: investigation of hypothalamic and pituitary contributions. J Clin Endocrinol Metab, 2006. 91(4): p. 1309-16. 11. Gordon, U.D., et al., A randomized prospective assessor-blind evaluation of luteinizing hormone dosage and in vitro fertilization outcome. Fertil Steril, 2001. 75(2): p. 324-31. 12. Carone, D., et al., Efficacy of different gonadotropin combinations to support ovulation induction in WHO type I anovulation infertility: clinical evidences of human recombinant FSH/human recombinant LH in a 2:1 ratio and highly purified human menopausal gonadotropin stimulation protocols. J Endocrinol Invest, 2012. 35(11): p. 996-1002. 13. McClure, N., et al., Age and follicular phase estradiol are better predictors of pregnancy outcome than luteinizing hormone in menotropin ovulation induction for anovulatory polycystic ovarian syndrome. Fertil Steril, 1993. 59(4): p. 729-33. 14. Sharara, F.I., R.T. Scott, Jr., and D.B. Seifer, The detection of diminished ovarian reserve in infertile women. Am J Obstet Gynecol, 1998. 179(3 Pt 1): p. 804-12. 15. Tarlatzis, B.C., et al., Clinical management of low ovarian response to stimulation for IVF: a systematic review. Hum Reprod Update, 2003. 9(1): p. 61-76. 16. Barnhart, K. and J. Osheroff, Follicle stimulating hormone as a predictor of fertility. Curr Opin Obstet Gynecol, 1998. 10(3): p. 227-32. 17. Bukman, A. and M.J. Heineman, Ovarian reserve testing and the use of prognostic models in patients with subfertility. Hum Reprod Update, 2001. 7(6): p. 581-90. 18. Creus, M., et al., Day 3 serum inhibin B and FSH and age as predictors of assisted reproduction treatment outcome. Hum Reprod, 2000. 15(11): p. 2341-6. 19. Mukherjee, T., et al., An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. Fertil Steril, 1996. 65(3): p. 588-93. 20. Barroso, G., et al., High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet, 2001. 18(9): p. 499-505. 21. Shrim, A., et al., Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response. Reprod Biomed Online, 2006. 12(4): p. 418-22.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Aralık 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 9 Sayı: 3 |
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