Oligo/Amenorrhea Is an Independent Risk Factor Associated With Low Ovarian Response.

Kai-Lun Hu,Yue Ying,Yifeng Liu,Yiqing Wu,Ruixue Chen,Yimin Zhu,Dan Zhang,Lanfeng Xing,Kwanghann Gan,Jinglei Xue,Junyan Zheng

doi:10.3389/fendo.2021.612042

Kai-Lun Hu, Yue Ying + Show 9 more

Open Access

https://doi.org/10.3389/fendo.2021.612042

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Abstract

CapsuleOligo/amenorrhea is an independent risk factor of low ovarian response but not high ovarian response, particularly in women with low AMH levels.ObjectiveTo investigate the association of menstrual cycle length (MCL) with anti-Müllerian hormone (AMH) and ovarian response.MethodsThis was a retrospective cohort study. A total of 7471 women who underwent ovarian stimulation and oocyte retrieval were enrolled. The main outcome was the number of oocytes retrieved.Main ResultsA total of 5734 patients were eligible for analysis. In women without polycystic ovary syndrome (PCOS), serum AMH levels and antral follicle count were significantly lower in women with short cycles and higher in women with oligo/amenorrhea than those with a normal menstrual cycle. In women with PCOS, compared to women with a normal menstrual cycle, women with short cycles and women with oligo/amenorrhea showed higher antral follicle count and higher serum AMH levels. Compared with the 0-25th range group of AMH levels, 75-100th percentile groups showed a significantly increased rate of oligo/amenorrhea in women with and without PCOS [adjusted odds ratio (OR) =1.9 (1.04, 3.46), 2.4 (1.70, 3.35)]. In women without PCOS, the low ovarian response was more common in women with short cycles and less common in women with oligo/amenorrhea compared to women with normal cycles [OR=3.0 (2.38, 3.78), 0.7 (0.55, 0.96), respectively]. When adjusted for AMH levels, both short cycles and oligo/amenorrhea were associated with an increased risk of low response [adjusted OR=1.3 (1.02, 1.75), 1.3 (0.93, 1.86), respectively]. In women without PCOS and with low AMH levels, the low ovarian response was more common in women with short cycles as well as in women with oligo/amenorrhea [OR=1.5 (1.08, 1.98), 1.7 (1.08, 2.69), adjusted OR=1.2 (0.86, 1.74), 2.2 (1.31, 3.82), respectively].ConclusionAMH levels are significantly associated with increased risk of oligo/amenorrhea in women with and without PCOS. AMH is an indispensable confounder in the association between MCL and ovarian response in women without PCOS. Oligo/amenorrhea is an independent risk factor associated with a low ovarian response in women without PCOS, particularly those with low AMH levels.

Highlights

Infertility is defined as the inability of a couple to get pregnant after one year of regular unprotected intercourse [1]
In women without polycystic ovarian syndrome (PCOS), the low ovarian response was more common in women with short cycles and less common in women with oligo/amenorrhea compared to women with normal cycles [odds ratio (OR)=3.0 (2.38, 3.78), 0.7 (0.55, 0.96), respectively]
When adjusted for antiMüllerian hormone (AMH) levels, both short cycles and oligo/amenorrhea were associated with an increased risk of low response [adjusted OR=1.3 (1.02, 1.75), 1.3 (0.93, 1.86), respectively]

Summary

Introduction

Infertility is defined as the inability of a couple to get pregnant after one year of regular unprotected intercourse [1]. A good marker to predict ovarian response may help clinicians to manage the doses of gonadotropins and other procedures in an IVF cycle. Many studies indicate that serum AMH levels can be used to predict IVF cycle success [9,10,11]. Serum AMH levels are considered as the best available measure of ovarian reserve under a variety of clinical conditions, including infertility treatment, the forecasting of reproductive lifespan, ovarian surgery, and gonadotoxic cancer therapy [12,13,14]. Emerging evidence shows that serum AMH levels can be used to predict ovarian response to exogenous gonadotropins [7, 14,15,16]

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