From the Guidelines
Diminished ovarian reserve is associated with an increased risk of miscarriage, as evidenced by a systematic review and meta-analysis published in 2021 in Human Reproduction Update 1. This association is thought to be due to the correlation between low ovarian reserve tests (ORTs), such as serum AMH concentration and AFC, and increased miscarriage risk.
- The study found that women with low values of these ORTs may have a higher risk of miscarriage, potentially due to the qualitative aspects of ovarian reserve, in addition to the quantitative aspects.
- However, the study also noted that the current evidence is insufficient to provide clinical recommendations due to methodological weaknesses and discrepancies between studies.
- Despite these limitations, the findings suggest that diminished ovarian reserve may be a risk factor for miscarriage, and preconception counseling and further research are needed to fully understand this relationship. Some potential strategies to manage diminished ovarian reserve and reduce miscarriage risk include:
- Supplementation with antioxidants and hormones, such as CoQ10 and DHEA, although the evidence for these interventions is limited
- Preimplantation genetic testing of embryos for women pursuing fertility treatment, which can help identify chromosomally normal embryos and potentially reduce miscarriage risk
- Early pregnancy monitoring with serial hCG measurements and early ultrasounds once pregnancy occurs, which can help identify potential complications early on. The connection between diminished ovarian reserve and miscarriage is complex and multifactorial, and further research is needed to fully understand the relationship between these two conditions and to develop effective strategies for reducing miscarriage risk in women with diminished ovarian reserve.
From the Research
Diminished Ovarian Reserve and Risk of Miscarriage
- Diminished ovarian reserve (DOR) has been linked to an increased risk of miscarriage, with studies suggesting that women with DOR may be more likely to experience recurrent pregnancy loss 2, 3.
- Ovarian reserve tests, such as antimüllerian hormone (AMH) and antral follicle count (AFC), can help identify women with DOR and may be useful in predicting the risk of miscarriage 4, 3.
- Research has shown that women with recurrent miscarriage (RM) tend to have lower AMH levels and higher follicle-stimulating hormone (FSH) levels compared to women without RM 2.
- A systematic review and meta-analysis found that women with recurrent pregnancy loss (RPL) were more likely to have DOR, as measured by low AMH levels and AFC, compared to women without RPL 3.
- The association between DOR and RPL was found to be stronger in women with unexplained RPL, suggesting that DOR may be a contributing factor to recurrent miscarriage in these cases 3.
Ovarian Reserve and Fertility
- Ovarian reserve is a complex clinical phenomenon influenced by age, genetics, and environmental variables 5, 6.
- The ideal ovarian reserve test should be convenient, reproducible, and have high specificity to minimize the risk of wrongly diagnosing women as having DOR 4.
- Ovarian reserve testing can help identify patients who will have poor response or hyperresponse to ovarian stimulation for assisted reproductive technology, and can inform patients regarding their reproductive lifespan and menopausal timing 4.
Prevention and Management of Ovarian Reserve Disorders
- Deciphering the mechanisms that underlie disorders of ovarian reserve could improve the outcomes for patients struggling with infertility 6.
- Primary prevention, or intervening before ablative influence occurs, is the most desirable mode of fertoprotection, and can reduce or eliminate exposure and damage to the ovaries 6.
- Secondary prevention, in the form of screening, may be recommended for women with a known genetic background or discrete family history of ovarian reserve disorders 6.
- Tertiary prevention, or managing disease post-diagnosis, is critical for reducing adverse effects and improving outcomes for women with ovarian reserve disorders 6.