{"id":108,"title":"The LH/large follicle ratio: a refined approach for risk stratification in IVF/ICSI cycles","title_zh":"LH/大卵泡比值：IVF/ICSI周期风险分层的精细化指标","url":"https://pubmed.ncbi.nlm.nih.gov/42972282","doi":"10.1186/s12884-026-09770-2","pmid":"42972282","journal":"BMC Pregnancy Childbirth","kind":"paper","lang":"en","published_at":"2026-08-06T00:00:00+00:00","fetched_at":"2026-11-08T03:43:53+00:00","authors":["Mao R","Zhou J","Wang M","Zhu L","Jin L"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":12.0,"hits":["clinical pregnancy","icsi","in vitro fertilization","ivf","live birth","trigger"]},{"slug":"oocyte","score":6.0,"hits":["antral follicle","follicle","follicular"]},{"slug":"repro-endo","score":3.0,"hits":["amh","anti-müllerian","luteinizing hormone"]},{"slug":"repro-tox","score":2.0,"hits":["bmi","body mass index"]},{"slug":"endometrium","score":1.0,"hits":["endometrial"]},{"slug":"repro-aging","score":1.0,"hits":["maternal age"]}],"topic_score":12.0,"preference_score":5.0,"preference_labels":["可转化到 ART 实验室的发现"],"llm_score":80.0,"final_score":85.0,"score_dims":{"novelty":76,"rigor":82,"impact":74,"relevance":95,"translation":78},"recommend_reason":"大样本回顾性队列，提出以LH/大卵泡数比值替代绝对LH进行风险分层，统计校正与ROC比较较规范，对触发日决策有直接参考价值；但为单中心回顾性设计，机制解释（卵泡稀释效应）仍属推测，需前瞻验证。","keywords":["LH/大卵泡比值","IVF/ICSI","风险分层","临床妊娠","活产","卵泡稀释效应"],"selected":1,"story_id":465,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":2,"has_interpretation":false,"journal_key":"bmc-preg","journal_tier":"standard","journal_if":2.8,"is_mock":false,"summary_zh":"本研究为回顾性队列研究，纳入8329个首次新鲜IVF/ICSI周期，在校正年龄、BMI、AMH、基础窦卵泡数、内膜厚度、移植胚胎数与发育阶段后，评估触发日血清LH/大卵泡数（LH/LF）比值与临床妊娠及活产的关系。结果显示，LH/LF比值是临床妊娠（OR=0.589）与活产（OR=0.599）的独立负向预测因子，其判别能力优于绝对LH水平（AUC 0.717 vs 0.651）。分层分析中，绝对LH偏高但比值偏低者临床妊娠率49.66%、活产率44.14%，显著高于双高组的33.39%与27.73%，作者据此提出“卵泡稀释效应”解释，结论尚待前瞻性外部验证。","summary":"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.","interpretation_basis":null,"fulltext_status":"ok","interpretation":null,"fulltext":{"available":true,"status":"ok","reason":"已取得 Europe PMC OA 全文","pmcid":"PMC13729427","license":"CC BY-NC-ND 4.0","chars":29998,"source":"Europe PMC","fetched_at":"2026-11-08T04:19:55+00:00"}}