The Clinical Utility of Early Follicular Phase Lh/Fsh Ratio as  a Presumptive Evidence of Ovulation in the Management of Infertile Women in Enugu, Nigeria

I. U. Nwagha

Department of Physiology/Obstetrics and Gynecology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.

ABSTRACT: Follicular maturation is initiated by follicle stimulating hormone (Fsh) and later assisted by luteinizing hormone (Lh).In the early phase of follicular maturation, the concentration of these hormones is in a particular equilibrium that ensures adequate ovulation. The extent of ovulatory dysfunction that will occur when this equilibrium is altered is variable. The objective of the study was to determine whether early follicular phase Lh/Fsh ratio can be used as a presumptive evidence of ovulation in a resource limited setting. This is a cross sectional study involving 110 women undergoing infertility treatment in Enugu between January 2007 and June 2008.Early follicular phase Fsh, Lh and midluteal phase progesterone was assayed using standard methods. The data was analyzed by descriptive and inferential statistics using the statistical package SPSS for windows version 13. Twenty six women (23.6%) had Lh/Fsh ratio of less than one with a mean progesterone of 10.2±2.4 ng/ml.Twenty two (20%) had Lh/Fsh ratio of 1-2 with mean progesterone of 13.9±3.4ng/ml.Majority, sixty two (56.4%) had Lh/Fsh ratio of more than 2, with mean progesterone of 5.5±1.5ng/ml.There is a statistically significant difference between Lh/Fsh ratios and the levels of progesterone (F = 13.169,P=000).Early follicular phase Lh/Fsh ratio of more than two may indicate anovulation.Thus in a resource limited setting, treatment can be instituted without recourse for further expensive investigation.

KEYWORDS: Lh/Fsh ratio; Infertility; Anovulation; Resource limited setting

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