Skip to content
DraconiticResearch
Search Sources API
194,161 studies31 sourcesUpdated 34 min ago
Peer-reviewedCC BY-NC-NDBMC pregnancy and childbirth

The LH/large follicle ratio: a refined approach for risk stratification in IVF/ICSI cycles.

  • Ruolin Mao1,2
  • Juepu Zhou1,2
  • Meng Wang1,2
  • Lixia Zhu1,2
  • Lei Jin3,4
4 affiliations
  1. 1Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
  2. 2National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
  3. 3Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. [email protected].
  4. 4National Clinical Research Center for Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. [email protected].
Read full textPDFDOICite

Abstract

Introduction

While serum luteinizing hormone (LH) on the day of trigger is a conventional predictor of in vitro fertilization (IVF) outcomes, its clinical utility remains inconsistent. This study aimed to evaluate the serum LH/large follicle (LH/LF) ratio as a refined risk-stratification marker for reproductive outcomes in IVF/ICSI cycles.Methods

A retrospective cohort study was conducted involving 8,329 first fresh IVF/ICSI cycles. Multivariable logistic regression models, adjusted for maternal age, body mass index (BMI), anti-Müllerian hormone (AMH), basal antral follicle count (Basal AFC), endometrial thickness, number of embryos transferred, and embryo developmental stage, evaluated the independent associations of the LH/LF ratio with the probability of clinical pregnancy and live birth. Predictive performance was compared with absolute LH levels using receiver operating characteristic (ROC) curves and the DeLong test.Results

The LH/LF ratio was identified as a significant independent negative predictor of clinical pregnancy (OR = 0.589, 95% CI: 0.540-0.644, P < 0.001) and live birth (OR = 0.599, 95% CI: 0.546-0.656, P < 0.001). For clinical pregnancy, the LH/LF ratio exhibited improved discriminative power compared to absolute LH levels (AUC = 0.717 vs. 0.651; P < 0.001). Stratification analysis revealed that within the elevated absolute LH population, the LH/LF ratio successfully differentiated a distinct subgroup (high LH but low ratio; Group C) that achieved a clinical pregnancy rate of 49.66% and an LBR of 44.14%, which were significantly higher than the 33.39% and 27.73% observed in the dual-high risk cohort (Group B; P < 0.01).Conclusions

The LH/LF ratio may provide valuable prognostic information for reproductive outcomes compared to absolute LH levels alone, which is consistent with the proposed follicular dilution effect. By integrating systemic hormonal profiles with follicular burden, this ratio provides a potentially useful framework for individualized clinical risk stratification in fresh cycles, pending future prospective external validation.

Related

  1. Recombinant follicle‐stimulating hormone (rFSH) versus other recombinant or urinary gonadotropins for ovarian stimulation in assisted reproductive technology cycles
    Robbert P Berkhout, Elena B Kostova, Madelon Wely
    The Cochrane Database of Systematic ReviewsPeer-reviewedPublisher termsFull text1 citedObstetrics, gynaecology & paediatricsPMC
  2. Admission White Blood Cell Count and Neutrophil‐to‐Lymphocyte Ratio for Early Risk Stratification after Spontaneous Intracerebral Hemorrhage: A Retrospective Cohort Study
    Guangyan Li, Gang Wang, Yuhang Hui +3
    Brain and behaviorPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  3. The comparison of short-term outcome between tenecteplase and alteplase in minor acute ischemic stroke based on neutrophil-to-lymphocyte ratio stratification
    Liangxu Xiang, Jing Xu, Zhaohai Feng +6
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textEpidemiology & public healthCrossref
  4. Combined assessment of fibrinogen-to-platelet ratio and ApoB/ApoA1 ratio for pre-angiographic risk stratification of severe multivessel coronary disease in NSTEMI.
    Zongqi Zhou, Wei Wang, Haoyu Zhou +4
    Frontiers in cardiovascular medicinePeer-reviewedCC BYFull textCardiovascular medicineEurope PMCCrossref
  5. Artificial intelligence-based prostate cancer risk stratification via large-scale ultrasound images paired with histopathology
    Qiong Zhang, Qiang Lu, Yu Liang +3
    Quantitative imaging in medicine and surgeryPeer-reviewedCC BY-NC-NDFull textMedical imaging & radiologyEurope PMC

Cite

BibTeXRIS
BibTeX
@article{mao2026lhlarge,
  title = {{The LH/large follicle ratio: a refined approach for risk stratification in IVF/ICSI cycles.}},
  author = {Ruolin Mao and Juepu Zhou and Meng Wang and Lixia Zhu and Lei Jin},
  journal = {BMC pregnancy and childbirth},
  year = {2026},
  month = aug,
  doi = {10.1186/s12884-026-09770-2},
  url = {https://europepmc.org/article/MED/42972282},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - The LH/large follicle ratio: a refined approach for risk stratification in IVF/ICSI cycles.
AU  - Ruolin Mao
AU  - Juepu Zhou
AU  - Meng Wang
AU  - Lixia Zhu
AU  - Lei Jin
PY  - 2026
DA  - 2026/08/06
JO  - BMC pregnancy and childbirth
DO  - 10.1186/s12884-026-09770-2
UR  - https://europepmc.org/article/MED/42972282
AB  - Introduction  While serum luteinizing hormone (LH) on the day of trigger is a conventional predictor of in vitro fertilization (IVF) outcomes, its clinical utility remains inconsistent. This study aimed to evaluate the serum LH/large follicle (LH/LF) ratio as a refined risk-stratification marker for reproductive outcomes in IVF/ICSI cycles.Methods  A retrospective cohort study was conducted involving 8,329 first fresh IVF/ICSI cycles. Multivariable logistic regression models, adjusted for maternal age, body mass index (BMI), anti-Müllerian hormone (AMH), basal antral follicle count (Basal AFC), endometrial thickness, number of embryos transferred, and embryo developmental stage, evaluated the independent associations of the LH/LF ratio with the probability of clinical pregnancy and live birth. Predictive performance was compared with absolute LH levels using receiver operating characteristic (ROC) curves and the DeLong test.Results  The LH/LF ratio was identified as a significant independent negative predictor of clinical pregnancy (OR = 0.589, 95% CI: 0.540-0.644, P < 0.001) and live birth (OR = 0.599, 95% CI: 0.546-0.656, P < 0.001). For clinical pregnancy, the LH/LF ratio exhibited improved discriminative power compared to absolute LH levels (AUC = 0.717 vs. 0.651; P < 0.001). Stratification analysis revealed that within the elevated absolute LH population, the LH/LF ratio successfully differentiated a distinct subgroup (high LH but low ratio; Group C) that achieved a clinical pregnancy rate of 49.66% and an LBR of 44.14%, which were significantly higher than the 33.39% and 27.73% observed in the dual-high risk cohort (Group B; P < 0.01).Conclusions  The LH/LF ratio may provide valuable prognostic information for reproductive outcomes compared to absolute LH levels alone, which is consistent with the proposed follicular dilution effect. By integrating systemic hormonal profiles with follicular burden, this ratio provides a potentially useful framework for individualized clinical risk stratification in fresh cycles, pending future prospective external validation.
SN  - 1471-2393
ER  -