We read with interest the study by Prasad et al. (1), on Correlation of Day 3 FSH/LH Ratio and LH Concentration in Predicting IVF Outcome. In this study, they demonstrated that elevated day 3 FSH/LH ratio is associated with inferior outcome in IVF treatment cycles and it could be used as an additional predictor of decreased ovarian reserve.
Surprisingly, two of our clinically relevant studies went unnoticed. While studying patients undergoing COH for IVF, with a favorable prognosis a priori, day 3 FSH: LH ratio, but not LH level, was found to predict IVF treatment outcome. Moreover, the FSH/LH ratio cutoff levels differ between those using the GnRH-agonist or GnRH-anta-gonist COH protocols. We demonstrated that patients undergoing ovarian stimulation using the GnRH antagonist with FSH/LH ratios >2, or using agonist protocols with FSH/LH ratios >3, achieved significantly lower pregnancy rates (2). Furthermore, in a subsequent study, we observed significantly higher number of top-quality embryos, and higher implantation and clinical pregnancy rates in patients undergoing COH for IVF, using HMG compared with rFSH (3).
Conflict of Interest
The authors declare no conflict of interest.