Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility

Greenwood, Eleni A.; Cedars, Marcelle I.; Santoro, Nanette; Eisenberg, Esther; Kao, Chia-Ning; Haisenleder, Daniel J.; Diamond, Michael P.; Huddleston, Heather G.

doi:10.1016/j.fertnstert.2017.09.015

Cited by 21 publications

(21 citation statements)

References 55 publications

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“…In addition, two recently published papers present noteworthy conclusions, showing that currently employed basal ORTs, AFC, and AMH do not discriminate women with infertility from healthy community-based women of similar demographic characteristics [29,30], in particular Greenwood et al who reported this conclusion based on a study which included women rigorously diagnosed with unexplained infertility [30]. The lead assumption in both papers stated that oocyte quantity predicts reproductive trajectory.…”

Section: Discussionmentioning

confidence: 99%

Do young women with unexplained infertility show manifestations of decreased ovarian reserve?

Abrahami

Izhaki

Younis

2019

J Assist Reprod Genet

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Purpose To investigate whether unexplained infertility at a young age demonstrates manifestations of decreased ovarian reserve. Methods 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. Results 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). Conclusions 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. Keywords Unexplained infertility. Ovarian reserve. (Basal) Ovarian reserve tests. Ovarian hyperstimulation. Bologna criteria * Johnny S.

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Section: Discussionmentioning

confidence: 99%

Do young women with unexplained infertility show manifestations of decreased ovarian reserve?

Abrahami

Izhaki

Younis

2019

J Assist Reprod Genet

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“…68 In a recent multicenter cross-sectional study, no differences in serum AMH and antral follicle count (AFC) were found between healthy normo-ovulatory women with unexplained infertility and women not seeking treatment for fertility, even after controlling for personal confounders or study site. 69 Finally, other recent studies had already demonstrated that AFC and AMH levels did not differ between fertile and infertile women of the same age, 70,71 and that spontaneous pregnancy may occur even in women presenting low AMH or AFC levels, or high FSH levels. 72,73 In the light of the current knowledge, ovarian reserve tests cannot be parameters for inferences about the reproductive potential in the medium or long term.…”

Section: Tests For Measuring Fertility Among Noninfertile Womenmentioning

confidence: 91%

Increasing the Chances of Natural Conception: Opinion Statement from the the Brazilian Federation of Gynecology and Obstetrics Associations - FEBRASGO - Committee of Gynecological Endocrinology

Carvalho

Barcelos

Medeiros

et al. 2019

Rev Bras Ginecol Obstet

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Considering that myths and misconceptions regarding natural procreation spread rapidly in the era of easy access to information and to social networks, adequate counseling about natural fertility and spontaneous conception should be encouraged in any kind of health assistance. Despite the fact that there is no strong-powered evidence about any of the aspects related to natural fertility, literature on how to increase the chances of a spontaneous pregnancy is available. In the present article, the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) Committee on Endocrine Gynecology provides suggestions to optimize counseling for non-infertile people attempting spontaneous conception.

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“…Greenhood et al, 2018 [26] Case-control study comparing women with unexplained infertility and healthy ovulatory controls not seeking pregnancy 227 cases and 226 controls AMH and AFC AMH 5.9 ± 5.2 vs 5.2 ± 3.9 ng/ml (p = ns). AFC 21 ± 11 vs 17 ± 9 (p = ns)…”

Section: Streuli Et Al 2014 [23]mentioning

confidence: 99%

“…In other words, the quality of the oocytes rather than the quantity of the residual primordial follicles would determine the chances of motherhood. Even if an initial study suggested some relation between the amount of the residual ovarian reserve and natural fertility in women older than 35 years [21], five subsequent independent studies in the general population failed to show any association between ovarian reserve and natural fertility [22][23][24][25][26]. This evidence is summarized in Table 2.…”

Section: Quality Of Oocytes and Ovarian Reservementioning

confidence: 99%

Chemotherapy-related damage to ovarian reserve in childhood cancer survivors: interpreting the evidence

Somigliana

Terenziani

Filippi

et al. 2018

J Assist Reprod Genet

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Chemotherapy during childhood damages ovarian reserve and can affect future fertility. However, recent large epidemiological studies showed that the detrimental impact on fertility is less severe if women seek for pregnancy at a younger age. To explain this observation, we hypothesize that the detrimental effects of previous chemotherapy on the ovarian reserve may be attenuated in young adults for two main reasons. Firstly, recent evidence showed that the amount of ovarian reserve is not a critical factor for effective natural conceptions. Provided that the residual ovarian reserve allows regular ovulatory cycles, the chances of pregnancy are similar in women with intact or reduced ovarian reserve. Secondly, ovarian reserve depletion appears to be a phenomenon that is inversely related to the residual ovarian reserve rather than to age. From a mathematical perspective, this kind of regulation intrinsically attenuates the effects of an early loss of a significant amount of primordial follicles. In conclusion, the detrimental effects of chemotherapy on natural fertility may be less severe if women with a history of chemotherapy during childhood seek for pregnancy early. This information should be part of the counseling.

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Antimüllerian hormone levels and antral follicle counts are not reduced compared with community controls in patients with rigorously defined unexplained infertility

Cited by 21 publications

References 55 publications

Do young women with unexplained infertility show manifestations of decreased ovarian reserve?

Do young women with unexplained infertility show manifestations of decreased ovarian reserve?

Increasing the Chances of Natural Conception: Opinion Statement from the the Brazilian Federation of Gynecology and Obstetrics Associations - FEBRASGO - Committee of Gynecological Endocrinology

Chemotherapy-related damage to ovarian reserve in childhood cancer survivors: interpreting the evidence

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