Early prediction of ovarian multifollicular response during ovulation induction in patients with polycystic ovary syndrome

Objective: To examine the association between the midfollicular FSH-LH ratio and the number of follicles, and the multifollicular ovarian response to gonadotropin stimulation in patients with polycystic ovary syndrome (PCOS) with normal basal LH and FSH levels. Subject(s): Eighteen patients who had an abandoned treatment cycle because of multifollicular ovarian response. For comparison, all other completed treatment cycles in the same group of patients were used. Main Outcome Measure(s): The dose of hMG or FSH, daily effective dose, day 8 serum FSH and LH concentration, day 8 number of follicles ≤8 mm, E₂ and number of follicles on hCG day or day of cycle was abandoned. Result(s): In the abandoned cycles, day 8 serum LH concentrations were significantly lower and day 8 number of follicles and FSH-LH ratios were significantly higher compared with the completed cycles. A high predictive power (>90%) for multifollicular response was established by using a set of two criteria: a FSH-LH ratio ≤1.6 and the number follicles ≤7 as the cutoff point. Conclusion(s): When aiming for a monofollicular response in women with PCOS and normal basal FSH and LH levels, cycles with high midfollicular FSH- LH ratios (≤1.6) and a high number of follicles (≤7) are those prone to develop a multifollicular ovarian response.