Diminished ovarian reserve is not independently associated with clinical reproductive loss in pregnancies achieved by assisted reproductive technologies (ART)

Abstract

ObjectivePrior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART.DesignRetrospective cohort.Materials and MethodsThe study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH ≥14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 8-13.9, or ≥14 IU/L.ResultsTabled 1FSH (IU/L)<88-13.9≥14# OF SUBJECTS60522125AGE (YEARS)33.535.035.6CLINICAL PREGNANCY LOSS24.3%28%28.% Open table in a new tab ConclusionAfter adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age. ObjectivePrior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART. Prior studies have suggested that women with diminished ovarian reserve (DOR) are at higher risk for reproductive loss, independent of age. These studies, however, did not distinguish very early losses from losses after clinical detection of an intrauterine pregnancy (IUP). Here we examined the rate of reproductive loss after sonographic identification of an IUP in a cohort of women with DOR compared to women with normal ovarian reserve undergoing ART. DesignRetrospective cohort. Retrospective cohort. Materials and MethodsThe study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH ≥14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 8-13.9, or ≥14 IU/L. The study cohort consisted of all fresh autologous ART cycles that resulted in a first singleton clinical IUP (sonographic identification of a single gestational sac at approximately 6-7 weeks gestational age) from Jan-Dec 2009 at a single fertility practice, verified by chart review. DOR was defined by basal serum FSH ≥14 IU/L. Patients were excluded if no FSH level was measured within one year of the cycle analyzed or if the patient had only one ovary. Patients were grouped by FSH <8, 8-13.9, or ≥14 IU/L. ResultsTabled 1FSH (IU/L)<88-13.9≥14# OF SUBJECTS60522125AGE (YEARS)33.535.035.6CLINICAL PREGNANCY LOSS24.3%28%28.% Open table in a new tab ConclusionAfter adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age. After adjusting for age, there was no relationship between basal serum FSH concentration and pregnancy loss greater than 6-7 weeks gestational age in women achieving IUP through ART. The higher pregnancy loss rates previously reported in women with DOR may be due to loss prior to 6-7 weeks gestational age.