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Case 1

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Question 1 Feedback -- LH

Interesting but not indicated initially in this patient's presentation.

You may investigate this further:

Our patient has no hirsutism, acne, excess weight, or consistent history of irregular cycles suggestive of long term anovulation problems. If she had a history of such problems an evaluation of these hormones may be indicated to document the possible diagnosis of polycystic ovarian syndrome (PCOS).

Anovulation secondary to polycystic ovarian syndrome is characterized by the following clinical features: polycystic ovaries by ultrasound, hirsutism, amenorrhea, acne, weight gain and infertility.

Recent clinical studies documented hirsutism in 64.7% of an adolescent group and in 49.6% of the adult group with PCOS by ultrasound criteria. Menstrual irregularities were classified as oligomenorrhea (> 40% in both groups), amenorrhea (> 20% in the adolescents and 8.8% in adults) , and irregular but normal cycles (17.4% and 23.2% respectively). See this PubMed reference.

Gulekli B, Turhan NO, Senoz S, Kukner S, Oral H, Gokmen O. Endocrinological, ultrasonographic and clinical findings in adolescent and adult polycystic ovary patients: a comparative study. Gynecol Endocrinol 1993 Dec;7(4):273-277.

Other references:

Basal LH/FSH ratios in women with polycystic ovarian syndrome classically have a reversal of the normal ratio of FSH to LH (LH:FSH = 2.5:1) . LH levels along with testosterone levels and the number of small follicles may predict the success of ovulation induction with clomiphene citrate. Small multiple follicles (> 9) and an enlarged ovarian volume (> 6.8 ml) were the most prominent transvaginal ultrasonographic features of ovaries in clomiphene citrate nonresponsive women with PCOS. See this PubMed reference:

Ficicioglu C, Api M, Ozden S. The number of follicles and ovarian volume in the assessment of the response to clomiphene citrate in polycystic ovarian syndrome. Acta Eur Fertil 1995 May;26(3):101-104.

High LH/FSH ratios are predictive of poor ovarian responses to gonadotropin stimulation and indicate a greater chance for a miscarriage. See this PubMed reference:

Tarlatzis BC, Grimbizis G, Pournaropoulos F, Bontis J, Lagos S, Spanos E, Mantalenakis S. The prognostic value of basal luteinizing hormone:follicle-stimulating hormone ratio in the treatment of patients with polycystic ovarian syndrome by assisted reproduction techniques. Hum Reprod 1995 Oct;10(10):2545-2549.

Basal LH values greater than 6mIU/ml appear to have a positive predictive value of over 90% in detecting women with PCOS as defined by an explosive response to GnRH stimulation. See this PubMed reference:

Oppermann K, Cho MM, Spritzer PM. Serum LH levels in the differential diagnosis of hirsute anovulatory women. Braz J Med Biol Res 1993 Aug;26(8):799-803.

For further inquiries regarding PCOS see this PubMed database search (the results of this search will change as new literature is added to the PubMed database).

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