Impact of concordance between basal LH/FSH ratio and testosterone levels on pregnancy outcomes in patients with PCOS undergoing IVF-ET cycle: a retrospective cohort study

Abstract Objective To investigate the association of testosterone levels on ovarian stimulation response in PCOS patients—stratified by serum LH/FSH ratio—undergoing IVF-ET. Methods A total of 1,354 PCOS patients who underwent fresh embryo transfer were ultimately included in the study. we analyzed and classified it according to the basal LH/FSH ratio values into the following groups: the LH/FSH ≥ 2 group (412 cases) and the LH/FSH < 2 group (942 cases). According to the value of basal serum T level, there were 488 cases in the high T group (> 0.75 ng/ml) and 866 cases in the non-high T group (≤ 0.75 ng/ml), and the outcomes of embryo transfer cycles were compared among the patients in each group. Results Based on the LH/FSH ratio and testosterone (T) levels, patients were divided into four groups: Group A (LH/FSH < 2, T ≤ 0.75 ng/ml), Group B (LH/FSH < 2, T > 0.75 ng/ml), Group C (LH/FSH ≥ 2, T ≤ 0.75 ng/ml), and Group D (LH/FSH ≥ 2, T > 0.75 ng/ml). There were no statistically significant differences in embryo quality among the four groups ( P > 0.05). Regarding pregnancy outcomes, Group B had the lowest live birth rate (51.56%), which was significantly lower than those of Group A (61.87%), Group C (59.79%), and Group D (68.10%)( P ≤ 0.05). Meanwhile, Group B had the highest miscarriage rate (22.38%), significantly higher than the other three groups (10.98%, 12.43%, and 12.90%) ( P ≤ 0.05). After adjusting for confounding factors, logistic regression analysis using Group A as the reference showed that Group B had a significantly increased risk of miscarriage ( OR = 2.200, 95% CI = 1.325–3.653, P = 0.002) and a significantly lower live birth rate ( OR = 0.719, 95% CI = 0.520–0.994, P = 0.046). Conclusion In patients with PCOS, a high LH/FSH ratio accompanied by elevated testosterone levels was not strongly associated with the likelihood of achieving a live birth. However, in the subgroup with an LH/FSH ratio ≤ 2, elevated testosterone levels may be associated with a reduced likelihood of live birth and an increased risk of miscarriage.