Diminished ovarian reserve is not associated with an increase in miscarriage among younger women achieving pregnancy through IVF. Elevated FSH is associated with a higher risk of IVF pregnancy loss among older patients. We found no evidence to confirm that diminished ovarian reserve is associated with increased aneuploidy among spontaneous abortions.

Objective To define whether anti-mullerian hormone may be a marker of acute cyclophosphamide-induced germ cell destruction in mice pretreated with the GnRH antagonist, cetrorelix. Design Controlled, experimental study. Setting Research laboratory in a federal research facility. Animals Balb/c female mice (6 weeks old). Interventions Mice were treated with GnRH antagonist (cetrorelix) or saline for 15 days followed by 75 mg/kg or 100 mg/kg of cyclophosphamide or saline control on day 9. Main Outcome Measure(s) Number of primordial follicles (PMF), DNA damage, AMH protein expression, and AMH serum levels. Results Ovaries in mice pre-treated with cetrorelix had significantly more PMF and reduced DNA damage compared to those exposed to cyclophosphamide alone. Immunohistochemical staining for AMH expression and serum AMH levels did not differ significantly between treatment groups. Conclusions Cetrorelix protected primordial follicles and reduced DNA damage in follicles of mice treated with cyclophosphamide, but AMH levels in tissue and serum did not correlate with germ cell destruction. Further research is needed to determine the mechanism responsible for the protective effects on PMF counts observed with cetrorelix.

Objective To determine a minimum number of procedures required for proficiency in oocyte retrieval and to characterize skill acquisition. Design Retrospective analysis. Setting Reproductive Endocrinology and Infertility fellowship training program. Study subjects Fellows in training from 2005-2007 and 2008-2010. Interventions None. Main outcome measures Proficiency scores (PS) were calculated by dividing the number of oocytes retrieved by oocytes expected (PS=oocytes retrieved/expected). 2005-2007 trainees were grouped and proficiency scores calculated as an average during specific points in their training. 2008-2010 trainees were compared individually to determine differences in individual skill acquisition. Results A greater number of oocytes were retrieved than expected, 8.6 vs. 7.6 (p <0.05). A relatively lower proficiency score (PS) was noted during the first 10 trainee aspirations (PS=1.1) compared to subsequent aspirations (PS=1.25 retrievals 11-20, PS=1.21 retrievals 21-30 and >31). When individual fellows’ scores were calculated, the majority achieved proficiency by 20 aspirations and all but one trainee achieved the mean staff PS by 50 retrievals. Conclusions Regardless of a trainee’s initial proficiency in oocyte retrieval, there are no statistically significant differences in the learning curve between trainees. The majority of individual fellows in training demonstrate proficiency in follicular aspirations within 20 procedures; however, a minority may require 50 procedures to achieve the proficiency of an attending physician. Capsule The majority of fellows in training demonstrate proficiency in follicular aspirations within 20 procedures; however, a minority may require 50 procedures to achieve the proficiency of an attending physician.