A 26‑year‑old woman with PCOS and high basal luteinizing hormone (LH) kept failing to get pregnant with standard IVF hormone protocols that used GnRH agonists or antagonists. When doctors switched to a different approach—using a progestin‑primed ovarian stimulation (PPOS) protocol together with the aromatase inhibitor letrozole and skipping any LH‑lowering pretreatment—the cycle worked and she had a healthy baby. This shows that high basal LH isn’t always a deal‑breaker for IVF, and alternative hormone regimens can rescue a failed cycle.

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.