1 3 J Endocrinol Invest DOI 10.1007/s40618-015-0429-x ORIGINAL ARTICLE What is the best treatment for women with polycystic ovarian syndrome and high LH/FSH ratio? A comparison among in vitro fertilization with GnRH agonist, GnRH antagonist and in vitro maturation Y. Ganor‑Paz 1,2 · Y. Friedler‑Mashiach 1 · Y. Ghetler 1,2 · A. Hershko‑Klement 1,2 · A. Berkovitz 1,2 · O. Gonen 1,2 · A. Shulman 1,2 · A. Wiser 1,2 Received: 28 May 2015 / Accepted: 28 December 2015 © Italian Society of Endocrinology (SIE) 2016 Introduction Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies; affecting 5–10 % of women of reproductive age [1]. The absolute level of circulating LH and its relation to FSH levels are significantly higher in women with PCOS, compared to healthy women. The LH/ FSH ratio may be elevated in 35–90 % of patients [2] due to increased amplitude and frequency of LH pulses [3]. Reports regarding the potential effects of high LH levels on human reproduction, conflict. Some studies have sug- gested that high LH levels have potentially adverse effects on oocyte maturity and fertilization [4], as well as lower pregnancy and higher miscarriage rates [5]. However, other studies showed no negative effect of LH on oocyte and embryo quality or on fertilization, implantation, and preg- nancy rates [6, 7]. The 2003 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group [8] revised the diagnostic cri- teria for PCOS and decided that measurement of serum LH levels is not necessary for a diagnosis of PCOS. The Con- sensus Workshop Group mentioned that additional research is needed to clarify the clinical relevance of LH in PCOS. The optimal protocol for women with PCOS who failed to conceive after controlled ovarian stimulation has not yet been defined. The subgroup of PCOS and high LH/FSH ratio is unique, because the potential of harmful effects from LH is higher. Recently, Orvieto et al. [9] evaluated whether a high basal day-3 LH/FSH ratio affects IVF cycle outcomes in PCOS patients undergoing ovarian stimulation with either GnRH agonist or antagonist. The PCOS patients with high LH/ FSH ratios showed a trend toward higher pregnancy rates using the GnRH-agonist compared to the GnRH-antagonist Abstract Purpose To evaluate whether high LH/FSH ratio has a clinical impact on patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization (IVF) with GnRH- agonist/antagonist protocols or in vitro maturation (IVM) treatments. Methods We retrospectively reviewed all PCOS patients with day 3 LH/FSH ratio ≥1.5 who underwent IVF or IVM. The main outcomes measures were embryo quality and pregnancy rate. Results A total of 75 cycles were included. Among these, 44 patients underwent long agonist protocol, 16 antago- nist protocol and 15 IVM. Age, basal LH and FSH levels, as well as duration of infertility were comparable for all groups. The LH level on the day of hCG administration was significantly lower in the antagonist group (0.9 IU/ml) compared to the long agonist group (1.4 IU/ml, p = 0.01). There was no difference in pregnancy rates among the groups: 27.2 % in the long agonist group, 37.5 % in the antagonist group and 26.6 % among the IVM patients. Conclusions High LH/FSH ratio had no adverse effect on pregnancy rates in all three treatment modes. Keywords PCOS · IVF · IVM · High LH/FSH ratio * Y. Ganor-Paz yael.ganor@gmail.com 1 Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tshernichovsky Street, Kfar Saba, Israel 2 Tel Aviv University, Tel Aviv, Israel