J Korean Med Sci.  2015 Mar;30(3):296-300. 10.3346/jkms.2015.30.3.296.

Correlation between the Serum Luteinizing Hormone to Folliclestimulating Hormone Ratio and the Anti-Mullerian Hormone Levels in Normo-ovulatory Women

• Lee JE
• Yoon SH
• Kim HO
• Min EG

• KMID: 2133308
• DOI: http://doi.org/10.3346/jkms.2015.30.3.296

Abstract

Serum anti-Mullerian hormone (AMH) levels are regarded as an age-specific marker for predicting the ovarian reserve in women of reproductive age. Some studies have shown that the luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio can be used as a predictor of ovarian reserve. The purpose of this study was to assess the variation of LH/FSH ratio with aging and to evaluate the correlation between serum LH/FSH ratio and AMH levels as a predictor of the ovarian reserve in normo-ovulatory women. We retrospectively analyzed the day 3 serum hormone levels in 1,251 patients (age range: 20-50 yr) between January 2010 and January 2011. We divided the patients into 6 groups according to their age. Relation between serum AMH level and LH/FSH ratio was analyzed statistically. The serum AMH level was inversely correlated with age (r = -0.400, P < 0.001). A significant negative correlation was found between serum LH/FSH ratio and age (r = -0.213, P < 0.001). There was a significant partial correlation between serum LH/FSH ratio and AMH level when adjusted by age (r = 0.348, P < 0.001). The LH/FSH ratio could be considered as a useful marker for the ovarian reserve and could be applied to the clinical evaluation with AMH.

Keyword

Anti-Mullerian Hormone; LH/FSH Ratio; Regular Menstruation; Ovarian Reserve

MeSH Terms

Adult
Aging/blood
Anti-Mullerian Hormone/*blood
Female
Follicle Stimulating Hormone/*blood
Humans
Luteinizing Hormone/*blood
Menstruation/blood/physiology
Middle Aged
Ovarian Reserve/*physiology
Ovulation/*blood/physiology
Retrospective Studies
Young Adult
Anti-Mullerian Hormone
Follicle Stimulating Hormone
Luteinizing Hormone

Figure

• 

  Fig. 1 Distribution of serum anti-Müllerian hormone (AMH) (A), follicle stimulating hormone (FSH) (B) and luteinizing hormone (LH)/FSH ratio (C) according to age. (A) Correlation analysis between serum AMH levels and age. The serum AMH levels are inversely correlated with age (r = -0.4, P < 0.001). (B) Correlation analysis between serum FSH levels and age. The serum FSH levels are positively correlated with age (r = 0.282, P < 0.001). (C) Correlation analysis between LH/FSH ratios and age. A significant negative correlation is demonstrated between the serum LH/FSH ratios and age (r = -0.213, P < 0.001).

Reference

1. Gougeon A, Ecochard R, Thalabard JC. Age-related changes of the population of human ovarian follicles: increase in the disappearance rate of non-growing and early-growing follicles in aging women. Biol Reprod. 1994; 50:653–663.

2. Van Rooij IA, Broekmans FJ, Hunault CC, Scheffer GJ, Eijkemans MJ, De Jong FH, Themmen AP, te Velde ER. Use of ovarian reserve tests for the prediction of ongoing pregnancy in couples with unexplained or mild male infertility. Reprod Biomed Online. 2006; 12:182–190.

3. Al-Azemi M, Killick SR, Duffy S, Pye C, Refat B, Hill N, Ledger W. Multi-marker assessment of ovarian reserve predicts oocyte yield after ovulation induction. Hum Reprod. 2011; 26:414–422.

4. Gleicher N, Weghofer A, Barad DH. Defining ovarian reserve to better understand ovarian aging. Reprod Biol Endocrinol. 2011; 9:23.

5. Shin SY, Lee JR, Noh GW, Kim HJ, Kang WJ, Kim SH, Chung JK. Analysis of serum levels of anti-Müllerian hormone, inhibin B, insulin-like growth factor-I, insulin-like growth factor binding protein-3, and follicle-stimulating hormone with respect to age and menopausal status. J Korean Med Sci. 2008; 23:104–110.

6. Sills ES, Alper MM, Walsh AP. Ovarian reserve screening in infertility: practical applications and theoretical directions for research. Eur J Obstet Gynecol Reprod Biol. 2009; 146:30–36.

7. Yoo JH, Kim HO, Cha SW, Park CW, Yang KM, Song IO, Koong MK, Kang IS. Age specific serum anti-Müllerian hormone levels in 1,298 Korean women with regular menstruation. Clin Exp Reprod Med. 2011; 38:93–97.

8. La Marca A, Volpe A. Anti-Müllerian hormone (AMH) in female reproduction: is measurement of circulating AMH a useful tool? Clin Endocrinol (Oxf). 2006; 64:603–610.

9. Almog B, Shehata F, Suissa S, Holzer H, Shalom-Paz E, La Marca A, Muttukrishna S, Blazar A, Hackett R, Nelson SM, et al. Age-related normograms of serum antimüllerian hormone levels in a population of infertile women: a multicenter study. Fertil Steril. 2011; 95:2359–2363.

10. Barad DH, Weghofer A, Gleicher N. Utility of age-specific serum anti-Müllerian hormone concentrations. Reprod Biomed Online. 2011; 22:284–291.

11. La Marca A, Sighinolfi G, Giulini S, Traglia M, Argento C, Sala C, Masciullo C, Volpe A, Toniolo D. Normal serum concentrations of anti-Müllerian hormone in women with regular menstrual cycles. Reprod Biomed Online. 2010; 21:463–469.

12. Seifer DB, Baker VL, Leader B. Age-specific serum anti-Mullerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertil Steril. 2011; 95:747–750.

13. Guastella E, Longo R, Carmina E. Clinical and endocrine characteristics of the main polycystic ovary syndrome phenotypes. Fertil Steril. 2010; 94:2197–2201.

14. Liu KE, Greenblatt EM. Elevated day 3 follicle-stimulating hormone/luteinizing hormone ratio ≥ 2 is associated with higher rates of cancellation in vitro fertilization-embryo transfer cycles. Fertil Steril. 2008; 90:297–301.

15. Barroso G, Oehninger S, Monzó A, Kolm P, Gibbons WE, Muasher SJ. 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; 18:499–505.

16. Seckin B, Turkcapar F, Ozaksit G. Elevated day 3 FSH/LH ratio: a marker to predict IVF outcome in young and older women. J Assist Reprod Genet. 2012; 29:231–236.

17. Kim YK, Wasser SK, Fujimoto VY, Klein NA, Moore DE, Soules MR. Utility of follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol and FSH:LH ratio in predicting reproductive age in normal women. Hum Reprod. 1997; 12:1152–1155.

18. Park I, Lee KH, Sun HG, Kim SK, Lee JH, Jeon GH. High accuracy predictions of IVF prognosis attained using a combination of AMH and day 3 FSH/LH ratio. Fertil Steril. 2011; 96:S190.

19. Spandorfer SD, Chung P, Davis O, Rosenwaks Z. FSH to LH ratio on day 2 is predictive of IVF outcome in no Leuprolide IVF stimulation cycles in poor responders. Fertil Steril. 2005; 84:S43.