Do young women with unexplained infertility show manifestations of decreased ovarian reserve?
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To investigate whether unexplained infertility at a young age demonstrates manifestations of decreased ovarian reserve.
A total of 100 women were divided into two equally sized groups. The study group comprised women aged ≤ 37 years diagnosed with unexplained infertility, and the control group included age-matched women with either mechanical factor or severe male factor infertility.
Both groups were comparable in their basic characteristics. Overall, women with unexplained infertility presented with inferior ovarian reserve results set against women of the control group. The number of ≥ 14-mm follicles on the day of hCG administration was significantly lower in the study compared with the control group (7.0 ± 4.5 vs. 10.4 ± 4.1 follicles, respectively, P < 0.001). Likewise, basal serum FSH was higher in the study compared with the control group (8.4 ± 5.5 vs. 6.4 ± 1.7 IU/L, respectively, P = 0.015), while antral follicle count was lower (10.9 ± 6.6 vs. 16.2 ± 6.6 follicles, respectively, P < 0.001). Furthermore, women with unexplained infertility required a higher total dose of FSH for ovarian stimulation (2,923 ± 1,701 vs. 2,196 ± 941 IU/L, respectively, P = 0.010), but exhibited a lower number of retrieved oocytes (9.3 ± 6.3 vs. 15.6 ± 7.9 oocytes, respectively, P < 0.001), alongside a lower number of achieved embryos (5.3 ± 4.0 vs. 8.0 ± 4.7 embryos, respectively, P = 0.002). Interestingly, the cumulative clinical pregnancy rate was not significantly different between the two groups (44% vs. 58%, respectively, P = 0.163).
Young women ≤ 37 years of age with unexplained infertility have clear manifestations of sub-optimal ovarian reserve set against controls. Our findings suggest that unexplained infertility at a young age may be a risk factor for developing poor ovarian response, specifically as a quantitative, rather than a qualitative, risk factor.
KeywordsUnexplained infertility Ovarian reserve (Basal) Ovarian reserve tests Ovarian hyperstimulation Bologna criteria
Compliance with ethical standards
Conflict of interests
The authors declare they have no conflict of interest.
Approval and waiver of written informed consent to retrieve and analyze the data was obtained from the Institutional Review and Ethical Committee of Poriya Medical Center. No additional interventions were performed to the routine clinical and laboratory standards in our unit.
- 2.Pandian Z, Gibreel A, Bhattacharya S. In vitro fertilisation for unexplained subfertility. Cochrane Database Syst Rev. 2015;(11):CD003357. https://doi.org/10.1002/14651858.CD003357.pub4.
- 11.Younis JS. The Bologna criteria for poor ovarian response; has the job been accomplished? Hum Reprod. 2012;27:1874–6. https://doi.org/10.1093/humrep/des118.
- 14.te Velde E, Habbema D, Leridon H, Eijkemans M. The effect of postponement of first motherhood on permanent involuntary childlessness and total fertility rate in six European countries since the 1970s. Hum Reprod. 2012;27:1179–83. https://doi.org/10.1093/humrep/der455.
- 20.Goverde AJ, McDonnell J, Schats R, Vermeiden JPW, Homburg R, Lambalk CB. Ovarian response to standard gonadotrophin stimulation for IVF is decreased not only in older but also in younger women in couples with idiopathic and male subfertility. Hum Reprod. 2005;20:1573–7. https://doi.org/10.1093/humrep/deh827.CrossRefGoogle Scholar
- 22.Randolph JF, Ginsburg KA, Leach RE, Blacker CM, Moghissi KS, Diamond MP, et al. Elevated early follicular gonadotropin levels in women with unexplained infertility do not provide evidence for disordered gonadotropin-releasing hormone secretion as assessed by luteinizing hormone pulse characteristics. Fertil Steril. 2003;80:320–7. https://doi.org/10.1016/S0015-0282(03)00612-5.CrossRefGoogle Scholar
- 26.Beckers NGM, Macklon NS, Eijkemans MJC, Fauser BC. Women with regular menstrual cycles and a poor response to ovarian hyperstimulation for in vitro fertilization exhibit follicular phase characteristics suggestive of ovarian aging. Fertil Steril. 2002;78:291–7. https://doi.org/10.1016/S0015-0282(02)03227-2.CrossRefGoogle Scholar
- 29.Hvidman HW, Bentzen JG, Thuesen LL, Lauritsen MP, Forman JL, Loft A, et al. Infertile women below the age of 40 have similar anti-Müllerian hormone levels and antral follicle count compared with women of the same age with no history of infertility. Hum Reprod. 2016;31:1034–45. https://doi.org/10.1093/humrep/dew032.CrossRefGoogle Scholar
- 30.Greenwood EA, Cedars MI, Santoro N, Eisenberg E, Kao CN, Haisenleder DJ, et al. Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility. Fertil Steril. 2017;108:1070–7. https://doi.org/10.1016/j.fertnstert.2017.09.015.CrossRefGoogle Scholar
- 32.Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum Reprod Update. 2013;19:26–36. https://doi.org/10.1093/humupd/dms041.CrossRefGoogle Scholar
- 40.Garcia-Velasco JA, Isaza V, Requena A, Martínez-Salazar FJ, Landazábal A, Remohí J, et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod. 2000;15(11):2292–6.CrossRefGoogle Scholar
- 45.Mukherjee T, Copperman AB, Lapinski R, Sandler B, Bustillo M, Grunfeld L. An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. Fertile Steril. 1996;65(3):588–93.CrossRefGoogle Scholar
- 52.Perez Mayorga M, Gromoll J, Behre HM, Gassner C, Nieschlag E, Simoni M. ovarian response to follicle-stimulating hormone (FSH) stimulation depends on the FSH receptor genotype. J Clin Endocrinol Metab. 2000;85(9):3365–9.Google Scholar
- 55.Behre HM, Greb RR, Mempel A, Sonntag B, Kiesel L, Kaltwasser P, et al. significance of a common single nucleotide polymorphism in exon 10 of the follicle-stimulating hormone (FSH) receptor gene for the ovarian response to FSH: a pharmacogenetic approach to controlled ovarian hyperstimulation. Pharmacogenet Genomics. 2005;15(7):451–6.CrossRefGoogle Scholar