Unexplained Infertility: A Biomarker for Decreased Ovarian Reserve in Young Women [15B

Abstract

INTRODUCTION: After 12 months of regular intercourse and appropriate evaluation to assure normal ovulation and sperm quality with patent fallopian tubes, no etiology is identified in up to 1/3 of couples. The treatment for Unexplained Infertility (UI), especially for younger couples (<35 years), is largely empiric. Recent IVF data suggests UI in younger women is associated with lower embryo quality and may be related to prematurely Decreased Ovarian Reserve (DOR). In the present study DOR, as measured by Anti-Mullerian Hormone (AMH), was assessed as part of the initial evaluation of young nulligravid couples with >12 months attempting pregnancy. METHODS: Three hundred and forty-three nulligravid couples (18-34 yrs) were evaluated with assessment of tubal patency, ovulatory and anatomic status by mid-cycle TVUS, comprehensive semen analysis, and assessment of DOR with serum AMH. RESULTS: An infertility diagnosis was confirmed in 142/343 (41%): anovulation 30%; anatomic abnormality 9%; male factor 6%. UI, the default diagnosis, was made in 201/343 (59%). Of the 201 women with UI, AMH was <95% of age appropriate values in 118 (59%). Most surprisingly, 53/201 (26%) UI women <35 had an AMH value of <1.5. CONCLUSION: The results of this study suggest 1) In all women with UI, independent of age, assessment of ovarian reserve should be included in the initial evaluation of fertility status; 2) In young women with premature DOR, consultation with a fertility specialist is warranted to discuss appropriate treatment modalities; 3) Beyond fertility concerns, DOR may herald a premature perimenopausal transition with the associated cardiovascular health implications.