Diminished ovarian reserve: is it a neglected cause in the assessment of recurrent miscarriage? A cohort study

Abstract

Objective: To study whether diminished ovarian reserve is associated with recurrent miscarriage.

Design: Cross-sectional clinical study.

Setting: Tertiary-care center.

Patient(s): Women with history of recurrent miscarriage (RM; n = 71) and sequentially selected age-matched fertile women who were seeking contraception (control; n = 70).

Intervention(s): Not applicable.

Main outcome measures(s): Serum levels of FSH, LH, E2, and antimüllerian hormone (AMH); FSH/LH ratio; ovarian volumes; and antral follicle count (AFC).

Result(s): The levels of FSH were 8.6 ± 3.7 U/L in the RM group and 7.1 ± 3.9 U/L in the control group; this difference was statistically significant. The levels of AMH were significantly lower in the RM group than in the control group (2.9 ± 1.7 ng/mL vs. 3.6 ± 1.7 ng/mL). The percentage of women with levels of FSH ≥11 U/L was significantly higher in the RM group than in the control group (18.3% vs. 4.3%). In the RM group, the percentage of women with levels of AMH ≤1 ng/mL was significantly higher than in the control group (19.7% vs. 5.7%).

Conclusion(s): Recurrent miscarriage may be associated with diminished ovarian reserve. Larger prospective randomized controlled trials are warranted to better determine the predictive potential of ovarian reserve markers in recurrent miscarriage.

Keywords: Antimüllerian hormone; antral follicle count; diminished ovarian reserve; ovarian reserve markers; recurrent miscarriage.