Decreased Ovarian Reserve: Is it an Independent Predictor of Adverse Obstetric Outcomes?

Abstract

To examine the impact of decreased ovarian reserve on adverse pregnancy outcomes. Retrospective cohort study in a tertiary care hospital. The medical records of all patients tested for ovarian reserve who achieved pregnancy through our infertility program between January 1 2000 and December 31 2004 were reviewed. Infertility history and treatment protocol was obtained through review of our infertility charts. Pregnancy and neonatal outcomes information was collected through medical records. Data collected included clomid challenge test results, first, second and third trimester pregnancy outcomes, antepartum complications and mode of delivery. Ovarian reserve testing was defined as a clomid challenge test with day 3 and day 10 FSH values available. Patients were classified as having normal ovarian reserve if both their day 3 and day 10 FSH values were less than 10 mIU/ml. Patients were classified as having abnormal ovarian reserve testing if either of their values was equal to or exceeded 10 mIU/ml. 35 patients with ovarian reserve testing had complete pregnancy outcomes information available. 22 patients had normal ovarian reserve testing and 13 patients had abnormal ovarian reserve testing. The average age of patients in the normal ovarian reserve testing group was 34.1 (range 28 to 40) versus 34.9 (range 32 to 39) for the abnormal ovarian reserve testing group. Significant past medical history was comparable between both groups (28.6 versus 33.3 %). No patients had previous pregnancy complications. The average day 3 FSH was 6.84 mIU/ml in the normal ovarian reserve group versus 9.33 mIU/ml in the abnormal group. The average day 10 FSH was 6.35 mIU/ml in the normal ovarian reserve group versus 12.46 in the abnormal ovarian reserve group. Estradiol levels were comparable between both groups (39.5 pg/ml and 38.6 pg/ml respectively).Pregnancy outcomes in the normal ovarian reserve group were as follows: 2 biochemical pregnancies (5.7%), 9 spontaneous abortions (25.7%), 1 ectopic pregnancy (2.9%), 1 second trimester loss (2.9%) and 22 live births (62.9%). Pregnancy outcomes in the decreased ovarian reserve group were 0 biochemical pregnancies, 5 spontaneous abortions (27.8%), 0 ectopic pregnancies or second trimester losses and 13 live births (72.2%) (P=NS). The number of twins and triplets was comparable between the two groups (8.6 versus 16.7%) and (2.9 versus 5.6 %) respectively (P=NS). The number of abnormal quadruple screen tests was comparable (2 versus 1) and so was the number of abnormal glucose tolerance tests (4 versus 2). There were 2 intrauterine growth restricted babies in the normal ovarian reserve group versus none in the abnormal ovarian reserve group as well as 2 versus 1 cases of oligohydramnios. In the normal ovarian reserve group versus the abnormal ovarian reserve group, there were 3 cases of preterm labor (13.6%) versus 4 (31%), 2 cases of hypertension (9.1%) versus 1 (8%), 1 case of diabetes (4.5%) versus 0 and 2 cases of other medical complications (9.1%) versus 0 (P=NS). 45.5% versus 46.2 % of patients delivered by cesarean section. The average birth weight was 2716 g in the normal ovarian reserve group versus 2452 g in the abnormal ovarian reserve group (P=NS). Ovarian reserve does not appear to negatively impact pregnancy outcomes in this group of patients.