Abstract
BackgroundOvarian reserve testing is not routinely performed in the evaluation of recurrent pregnancy loss (RPL). The objective of this study was to determine if AMH levels are predictive of live birth rate in RPL patients pursuing expectant management (EM).MethodsRetrospective cohort study of RPL patients. Patients tried to conceive spontaneously for 12 calendar months or until they achieved a live birth, whichever occurred first. All patients with the intent to conceive were included regardless of final outcome.ResultsOne hundred fifty-five RPL patients treated from 2009 to 2017 were included. In a univariate logistic regression, AMH < 1 ng/mL was associated with decreased likelihood of live birth (OR 0.38; CI 0.16–0.87, p = 0.03) and increasing age (OR 0.91; CI 0.83–0.99, p = 0.04). Likelihood of live birth was not significantly associated with BMI (OR 1.21; CI 0.83–1.77, p = 0.31), three or four or more prior pregnancy losses (OR 0.93; CI 0.40–2.22, p = 0.87 and OR 0.52; CI 0.19–1.42, p = 0.20, respectively) and prior live births (OR 1.00; CI 0.48–2.08, p = 0.99). AMH < 1 ng/mL was shown to be a stronger predictor of live birth than age using a multivariate model adjusting for age, AMH, and time to conception.ConclusionsAMH < 1 ng/mL is associated with decreased likelihood of live birth among RPL patients pursuing EM, and may be a stronger predictor of live birth than age in this population.
Highlights
Ovarian reserve testing is not routinely performed in the evaluation of recurrent pregnancy loss (RPL)
* Correspondence: gm807@stanford.edu Capsule of Abstract: AMH < 1 ng/mL is associated with decreased likelihood of live birth among RPL patients pursuing expectant management. 1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, Stanford, CA, USA Full list of author information is available at the end of the article
One hundred fifty-five RPL patients tried to conceive spontaneously for 12 months. 90% of patients had unexplained RPL, with 5% (n = 8) diagnosed with uterine anomalies and 5% (n = 7) diagnosed with anti-phospholipid syndrome (APS)
Summary
Ovarian reserve testing is not routinely performed in the evaluation of recurrent pregnancy loss (RPL). The objective of this study was to determine if AMH levels are predictive of live birth rate in RPL patients pursuing expectant management (EM). A large prospective cohort study of fertile women trying to conceive spontaneously found that AMH did not correlate with fecundability [8]. The role of AMH in predicting reproductive potential in RPL patients, defined as having two or more prior pregnancy losses, is unknown. A prospective cohort study of women attempting spontaneous conception after one or Murugappan et al Fertility Research and Practice (2019) 5:2 two prior pregnancy losses found that AMH was not associated with fecundability, while live birth was not separately examined [10]. The objective of our study is to examine the role, if any, of AMH in predicting live birth rate in RPL patients attempting spontaneous conception
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