Successful Pregnancy in a PCOS Patient with Elevated Basal Luteinizing Hormone and Repeated Ovulation Induction Failures: A Case Report

Abstract

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder characterized by chronic anovulation, hyperandrogenism, and polycystic ovarian morphology, leading to infertility. Elevated basal luteinizing hormone (bLH) levels in PCOS can impede the efficacy of ovulation induction (OI). This case report explores the management of a 26-year-old woman with PCOS and high bLH levels who experienced repeated failure in OI attempts. During in vitro fertilization-embryo transfer (IVF-ET) treatments, she underwent two cycles of controlled ovarian stimulation using long-acting gonadotropin-releasing hormone (GnRH) agonist and GnRH antagonist protocols respectively, both of which failed due to inadequate ovarian response despite normal bLH levels on the day of gonadotropin initiation. In the third cycle, a progestin-primed ovarian stimulation (PPOS) protocol combined with letrozole was adopted without bLH pretreatment, resulting in a successful pregnancy and healthy child after frozen-thawed embryo transfer. This case highlights the need for tailored approaches in managing PCOS patients with high bLH levels and indicates that elevated bLH may not always impair IVF outcomes. Further research is needed to establish the optimal bLH threshold and management protocols to enhance reproductive outcomes for these patients.