The usefulness of ovarian reserve tests (ORT) in evaluating IVF outcomes in infertile women aged ≤35 years is still debatable. Now, a recent retrospective database study reports that it may be beneficial for women of this age group to have their ovarian reserve tested for abnormal follicle-stimulating hormone (FSH) levels and antral follicle counts (AFC) before undergoing IVF treatment. The study findings were presented at the 65th American Society for Reproductive Medicine (ASRM) annual meeting held at Atlanta, from October 17th to 21st, 2009.
Todd Deutch and Richard Sherbahn, reproductive endocrinologists and infertility specialists at the Advanced Fertility Center of Chicago, Illinois, reviewed 1,380 IVF cycles in order to estimate the occurrence of abnormal FSH and/or AFC levels in women aged ≤35 years, undergoing IVF treatment. Treatment outcomes were also assessed in cycles with one or more abnormal ORTs. Based on the recorded AFC and FSH levels collected from the IVF database, four groups were formed, as listed in the table below. Using statistical tests such as z- and t-tests, IVF outcomes in groups with a minimum of one abnormal ORT were compared to the normal group; the results reported as follows:
| Parameters Tested | Normal FSH (<10) and AFC (>9) | Abnormal FSH (≥10) | Abnormal AFC (<10) | Abnormal FSH (≥10) and AFC (<10) |
| Mean Age (years) | 30.9 | 31.7 | 31.9 | 31.4 |
| Prevalence (%) | 79 | 9 | 14 | 2 |
| Pregnancy Rate (%) | 63 | 44 | 41 | 21 |
| Live Birth/Ongoing Pregnancy Rate (%) | 56 | 35 | 34 | 9 |
| Pregnancy Loss Rate (%) | 20 | 34 | 30 | 73 |
The findings demonstrated poor treatment outcomes in cycles with at least one abnormal ORT. Although both abnormal FSH and AFC levels were found in a relatively small percentage (2.5%) of the cycles, there existed a significantly high rate of pregnancy loss and an extremely low pregnancy rate in this group, despite their young age; thereby signifying the importance of ORT in young women seeking infertility treatment.
Earlier, El-Toukhy et al (Human Reproduction, 2002) conducted a study to assess IVF success rates in young women with depleted ovarian reserve. A total of 762 patients with confirmed ovarian reserve depletion, tested between January 1993 and 2001, were included in the study. The study population, with similar basal (day 3) serum FSH and estradiol levels, infertility cause, and number of treatment cycles, were grouped according to their chronological age, as young (≤30 years), intermediate (31 to 38 years), and old (>38 years). No significant differences in the implantation (13, 9.6 and 9.8%), clinical pregnancy (11.8, 10.2 and 10%), and live birth (7.4, 7.3 and 6.8%) rates were observed among the corresponding three age groups. Based on the findings, it was concluded that IVF outcomes were poor in young women with reduced ovarian reserve. Researchers also suggested that assessing ovarian reserve might be appropriate in pretreatment counseling of young infertile patients.
Contrary to these findings, a prospective cohort study by Lee et al (Reproductive Biology and Endocrinology, 2009) demonstrated that none of the ORTs, such as baseline FSH levels and anti-Müllerian hormone (AMH) levels, and AFC, were predictive of live births in women aged <35 years, or couples with male factor infertility. A similar earlier study by Ergur et al (International Congress Series, 2004) reported that ORTs, such as basal FSH and E2 concentrations, ovarian volume, and AFC on ovulation day-3, had no predictive value in young women at minimal risk of diminished ovarian reserve for fertility treatment outcome.
A plethora of ovarian reserve markers, such as day-3 levels of FSH, AFC, and clomiphene citrate challenge test, are helpful in qualitatively assessing IVF success rates. ASRM reports that the abnormal values of any of the ORTs generally reflect a reduced fertility potential. Although abnormal test results in younger women suggest a declining fertility potential, these tests fail to assess the chances of conception. A report by the Practice Committee of the ASRM (Fertility and Sterility, 2006) suggested that ORTs should be performed in women <35 years with a solitary ovary, previous ovarian surgery, unexplained infertility, poor response to exogenous gonadotropins, those who have undergone chemotherapy or radiotherapy, and in all infertile women >35 years who desire pregnancy.
References
1. Deutch TD, Sherbahn R. IVF Outcomes and Prevalence of Abnormal Ovarian Reserve Tests in Women 35 or Younger. Paper presented at: 65th Annual Meeting of the American Society for Reproductive Medicine;October 20,2009;Atlanta.
2. El-Toukhy T, Khalaf Y, Hart R, Taylor A, Braude P. Young age does not protect against the adverse effects of reduced ovarian reserve–an eight year study. Hum Reprod. 2002 Jun;17(6):1519-24.
3. Lee TH, Liu CH, Huang CC, Hsieh KC, Lin PM, Lee MS. Impact of female age and male infertility on ovarian reserve markers to predict outcome of assisted reproduction technology cycles. Reprod Biol Endocrinol. 2009 Sep 17;7:100.
4. Ergur AR, Tutuncu L, Dundar O, Yergok YZ. Basal ovarian reserve tests do not estimate follicular development in stimulated cycles of young infertile patients. International Congress Series. 2004 Sep;1271:26-29.
5. American Society for Reproductive Medicine. Patient’s Fact Sheet: Prediction of Fertility Potential (Ovarian Reserve) in Women. Last accessed November 30, 2009.
6. The Practice Committee of the American Society for Reproductive Medicine. Aging and Infertility in Women. Fertil Steril. 2006 Nov;86(4):248-252.
