2009년 미국불임학회(ASRM) O-288 Elevated day 3 FSH /LH ration and IVF prognosis in GNRH agonist VS. GNRH antagonist cycles. (생리시작 3일째 FSH/LH의 비율이 높은 것과 GnRH 효능제와 길항제 요법 사이의 임신율과의 관계)

K. H. Lee1, I. H. Park1, S. G. Kim1, S. J. Kim1, M. H. Kim2, J.D. Cho2.
1 Mamapapa & Baby Obstetrics and Gynecology, Ulsan, Korea;
2 Elle Medi OBGY, ChangWon, Kyeong Sang Nam Do, Korea.

OBJECTIVE

Day 3 FSH and LH are commonly used predictors of IVF prognosis, but they have a lower predictive value. Some studies have shown that the FSH/LH ratio can be used as an ovarian reserve marker. They showed that elevated FSH/LH ratio could predict poor IVF outcomes. However, there have been no studies that compared GnRH agonist and antagonist cycles when FSH/LH ratio was elevated. The purpose of this study was to compare IVF outcomes in GnRH agonist and GnRH antagonist cycles when day 3 FSH/LH ratio was elevated.

DESIGN

A retrospective cohort study.

MATERIALS AND METHODS

We retrospectively reviewed 560 patients undergoing IVF using GnRH agonist and antagonist protocols from January 2004 to December 2008. Our inclusion criteria included age<40, day 3 FSH < 10 IU/L. Day 3 FSH, LH level of included patient was checked within 3 months of IVF start. Three groups of patients were formed based on Day 3 serum FSH/LH ratio. Group I : FSH/LH <2; Group II : 2≤ FSH/LH <3; Group III : FSH/LH≥3. In each group, we compared ongoing pregnancy rates in GnRH agonist and GnRH antagonist cycles.

RESULTS

In each group the patients’ characteristics by age, parity and cause of infertility reflected no difference between the GnRH agonist group and the GnRH antagonist group. In Group I and II GnRH antagonist protocol had similar ongoing pregnancy rate as compared with GnRH agonist protocol [Group I:47.8%(56/117) vs. 46.5% (81/174), P=0.128; Group II:35.9%(23/64) vs. 39.4%(30/76), P=0.068]. In Group III, ongoing pregnancy rates of GnRH antagonist protocol were significantly lower than GnRH agonist protocol [19.1%(9/47) vs. 41.7%(33/79), P<0.001].

CONCLUSION

When day 3 FSH/LH ratio was elevated beyond 3, long protocol by GnRH agonist showed a much better outcome than GnRH antagonist protocol. Therefore, if day 3 FSH/LH ratio was elevated, long protocol by GnRH agonist was highly recommended. Day 3 FSH/LH ratio gives us good information when choosing between the GnRH agonist and the GnRH antagonist protocol.