Objective: To evaluate inappropriate gonadotropin secretion in women with polycystic ovary syndrome (PCOS). Design: Retrospective study. Setting: Academic tertiary center. Patient(s): A total of 373 women were classified into three groups:  healthy control women (n = 48);  women who were positive for PCOS risk factor; and  women with PCOS (n = 251). Intervention(s): None. Main Outcome Measure(s): Gonadotropin levels, LH-FSH ratio, body mass index, and clinical and/or biochemical presentations of PCOS. Result(s): The area under the receiver operating characteristic curve, used to predict PCOS for the LH-FSH ratio, showed similar diagnostic performance to total T and average ovarian volume. The LH-FSH ratio exhibits greater observed accuracy than total T and average ovarian volume for evaluation of women with oligomenorrhea or anovulation. An LH-FSH ratio of >1 presented the best combination of sensitivity and specificity. Body mass index was positively correlated with total T in non-PCOS and PCOS groups; however, body mass index was negatively correlated with LH in PCOS but showed no correlation in non-PCOS subjects. Conclusion(s): The LH-FSH ratio is a valuable diagnostic tool in evaluating women with PCOS and oligomenorrhea or anovulation, and an LH-FSH ratio of >1 may be used as a decision threshold. The link between body mass index and LH may provide clues for further understanding the pathological milieu of PCOS.
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