Recurrent pregnancy loss and diminished ovarian reserve

Abstract

Objective: To determine the incidence of diminished ovarian reserve (OR) in patients with recurrent pregnancy loss (RPL).

Design: Retrospective chart review.

Setting: Tertiary fertility center.

Patient(s): Six hundred ninety-two women undergoing a fertility evaluation.

Intervention(s): Clomiphene citrate challenge test (CCCT).

Main outcome measure(s): FSH concentrations measured on menstrual days 3 and 10.

Result(s): Forty-four women were diagnosed with RPL (+RPL), and 648 women had non-RPL diagnoses (-RPL). Compared with -RPL women, women with +RPL were younger (following statistics are listed as +RPL vs. -RPL, respectively; 34 +/- 5 vs. 35 +/- 4 y) but had similar menstrual cycle length (29 +/- 4 vs. 28 +/- 4 d), and lower day 3 FSH levels (8.9 + 7 vs. 11 +/- 9 mIU/mL) and similar day 10 FSH levels (11 +/- 8 vs. 12 +/- 11 mIU/mL). Eight of 44 women with +RPL (18%) had an abnormal CCCT, compared with 117/648 (18%) of women in the -RPL group. For women with normal OR, delivery rates were similar for -RPL and +RPL patients. For women with an abnormal CCCT, delivery rates were < 5%.

Conclusion(s): Women with RPL have a similar incidence of diminished OR as the general infertile population. Reproductive outcome for patients with an abnormal CCCT is equally poor for both groups. Ovarian reserve screening should be considered in the work-up of RPL before initiation of anticoagulant or immunotherapy.