Skip to main content
Top
Published in: Journal of Assisted Reproduction and Genetics 6/2019

01-06-2019 | Infertility | Assisted Reproduction Technologies

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

Authors: Noa Abrahami, Ido Izhaki, Johnny S. Younis

Published in: Journal of Assisted Reproduction and Genetics | Issue 6/2019

Login to get access

Abstract

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.
Literature
14.
go back to reference te Velde E, Habbema D, Leridon H, Eijkemans M. The effect of postponement of first motherhood on permanent involuntary childlessness and total fertility rate in six European countries since the 1970s. Hum Reprod. 2012;27:1179–83. https://doi.org/10.1093/humrep/der455. te Velde E, Habbema D, Leridon H, Eijkemans M. The effect of postponement of first motherhood on permanent involuntary childlessness and total fertility rate in six European countries since the 1970s. Hum Reprod. 2012;27:1179–83. https://​doi.​org/​10.​1093/​humrep/​der455.
18.
go back to reference Van Royen E, Mangelschots K, De Neubourg D, Valkenburg M, Van de Meerssche M, Ryckaert G, et al. Characterization of a top quality embryo, a step towards single-embryo transfer. Hum Reprod. 1999;14:2345–9.CrossRefPubMed Van Royen E, Mangelschots K, De Neubourg D, Valkenburg M, Van de Meerssche M, Ryckaert G, et al. Characterization of a top quality embryo, a step towards single-embryo transfer. Hum Reprod. 1999;14:2345–9.CrossRefPubMed
19.
go back to reference Seckin B, Turkcapar F, Ozaksit G. Elevated day 3 FSH/LH ratio: a marker to predict IVF outcome in young and older women. J Assist Reprod Genet. 2012;29(3):231–6.CrossRefPubMed Seckin B, Turkcapar F, Ozaksit G. Elevated day 3 FSH/LH ratio: a marker to predict IVF outcome in young and older women. J Assist Reprod Genet. 2012;29(3):231–6.CrossRefPubMed
20.
22.
go back to reference Randolph JF, Ginsburg KA, Leach RE, Blacker CM, Moghissi KS, Diamond MP, et al. Elevated early follicular gonadotropin levels in women with unexplained infertility do not provide evidence for disordered gonadotropin-releasing hormone secretion as assessed by luteinizing hormone pulse characteristics. Fertil Steril. 2003;80:320–7. https://doi.org/10.1016/S0015-0282(03)00612-5.CrossRefPubMed Randolph JF, Ginsburg KA, Leach RE, Blacker CM, Moghissi KS, Diamond MP, et al. Elevated early follicular gonadotropin levels in women with unexplained infertility do not provide evidence for disordered gonadotropin-releasing hormone secretion as assessed by luteinizing hormone pulse characteristics. Fertil Steril. 2003;80:320–7. https://​doi.​org/​10.​1016/​S0015-0282(03)00612-5.CrossRefPubMed
29.
31.
go back to reference Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718.CrossRefPubMed Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718.CrossRefPubMed
32.
35.
go back to reference Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231–45.CrossRefPubMed Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231–45.CrossRefPubMed
36.
go back to reference Land JA, Yarmolinskaya MI, Dumoulin JC, Evers JL. High-dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertile Steril. 1996;65(5):961–5.CrossRef Land JA, Yarmolinskaya MI, Dumoulin JC, Evers JL. High-dose human menopausal gonadotropin stimulation in poor responders does not improve in vitro fertilization outcome. Fertile Steril. 1996;65(5):961–5.CrossRef
37.
go back to reference Roest J, van Heusden AM, Mous H, Zeilmaker GH, Verhoeff A. The ovarian response as a predictor for successful in vitro fertilization treatment after the age of 40 years. Fertile Steril. 1996;66(6):969–73.CrossRef Roest J, van Heusden AM, Mous H, Zeilmaker GH, Verhoeff A. The ovarian response as a predictor for successful in vitro fertilization treatment after the age of 40 years. Fertile Steril. 1996;66(6):969–73.CrossRef
38.
go back to reference Lashen H, Ledger W, Lopez-Bernal A, Barlow D. Poor responders to ovulation induction: is proceeding to in-vitro fertilization worthwhile? Hum Reprod. 1999;14(4):964–9.CrossRefPubMed Lashen H, Ledger W, Lopez-Bernal A, Barlow D. Poor responders to ovulation induction: is proceeding to in-vitro fertilization worthwhile? Hum Reprod. 1999;14(4):964–9.CrossRefPubMed
39.
go back to reference Raga F, Bonilla-Musoles F, Casañ EM, Bonilla F. Recombinant follicle stimulating hormone stimulation in poor responders with normal basal concentrations of follicle stimulating hormone and oestradiol: improved reproductive outcome. Hum Reprod. 1999;14(6):1431–4.CrossRefPubMed Raga F, Bonilla-Musoles F, Casañ EM, Bonilla F. Recombinant follicle stimulating hormone stimulation in poor responders with normal basal concentrations of follicle stimulating hormone and oestradiol: improved reproductive outcome. Hum Reprod. 1999;14(6):1431–4.CrossRefPubMed
40.
go back to reference Garcia-Velasco JA, Isaza V, Requena A, Martínez-Salazar FJ, Landazábal A, Remohí J, et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod. 2000;15(11):2292–6.CrossRefPubMed Garcia-Velasco JA, Isaza V, Requena A, Martínez-Salazar FJ, Landazábal A, Remohí J, et al. High doses of gonadotrophins combined with stop versus non-stop protocol of GnRH analogue administration in low responder IVF patients: a prospective, randomized, controlled trial. Hum Reprod. 2000;15(11):2292–6.CrossRefPubMed
41.
go back to reference Weissman A, Farhi J, Royburt M, Nahum H, Glezerman M, Levran D. Prospective evaluation of two stimulation protocols for low responders who were undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2003;79(4):886–92.CrossRefPubMed Weissman A, Farhi J, Royburt M, Nahum H, Glezerman M, Levran D. Prospective evaluation of two stimulation protocols for low responders who were undergoing in vitro fertilization-embryo transfer. Fertil Steril. 2003;79(4):886–92.CrossRefPubMed
42.
go back to reference Macklon NS, Stouffer RL, Giudice LC, Fauser BC. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev. 2006;27(2):170–207.CrossRefPubMed Macklon NS, Stouffer RL, Giudice LC, Fauser BC. The science behind 25 years of ovarian stimulation for in vitro fertilization. Endocr Rev. 2006;27(2):170–207.CrossRefPubMed
43.
go back to reference Tazegül A, Görkemli H, Ozdemir S, Aktan TM. Comparison of multiple dose GnRH antagonist and minidose long agonist protocols in poor responders undergoing IVF. Arch Gynecol Obstet. 2008;278(5):467–72.CrossRefPubMed Tazegül A, Görkemli H, Ozdemir S, Aktan TM. Comparison of multiple dose GnRH antagonist and minidose long agonist protocols in poor responders undergoing IVF. Arch Gynecol Obstet. 2008;278(5):467–72.CrossRefPubMed
44.
go back to reference Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: mechanisms and clinical consequences. Endocr Rev. 2009;30(5):465–93.CrossRefPubMed Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: mechanisms and clinical consequences. Endocr Rev. 2009;30(5):465–93.CrossRefPubMed
45.
go back to reference Mukherjee T, Copperman AB, Lapinski R, Sandler B, Bustillo M, Grunfeld L. An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. Fertile Steril. 1996;65(3):588–93.CrossRef Mukherjee T, Copperman AB, Lapinski R, Sandler B, Bustillo M, Grunfeld L. An elevated day three follicle-stimulating hormone:luteinizing hormone ratio (FSH:LH) in the presence of a normal day 3 FSH predicts a poor response to controlled ovarian hyperstimulation. Fertile Steril. 1996;65(3):588–93.CrossRef
46.
go back to reference Barroso G, Oehninger S, Monzó A, Kolm P, Gibbons WE, Muasher SJ. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet. 2001;18(9):499–505.CrossRefPubMedPubMedCentral Barroso G, Oehninger S, Monzó A, Kolm P, Gibbons WE, Muasher SJ. High FSH:LH ratio and low LH levels in basal cycle day 3: impact on follicular development and IVF outcome. J Assist Reprod Genet. 2001;18(9):499–505.CrossRefPubMedPubMedCentral
47.
go back to reference Shrim A, Elizur SE, Seidman DS, Rabinovici J, Wiser A, Dor J. Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response. Reprod Biomed Online. 2006;12(4):418–22.CrossRefPubMed Shrim A, Elizur SE, Seidman DS, Rabinovici J, Wiser A, Dor J. Elevated day 3 FSH/LH ratio due to low LH concentrations predicts reduced ovarian response. Reprod Biomed Online. 2006;12(4):418–22.CrossRefPubMed
48.
go back to reference Liu KE, Greenblatt EM. Elevated day 3 follicle-stimulating hormone/luteinizing hormone ratio >or=2 is associated with higher rates of cancellation in in vitro fertilization-embryo transfer cycles. Fertile Steril. 2008;90(2):297–301.CrossRef Liu KE, Greenblatt EM. Elevated day 3 follicle-stimulating hormone/luteinizing hormone ratio >or=2 is associated with higher rates of cancellation in in vitro fertilization-embryo transfer cycles. Fertile Steril. 2008;90(2):297–301.CrossRef
49.
go back to reference Brodin T, Bergh T, Berglund L, Hadziosmanovic N, Holte J. High basal LH levels in combination with low basal FSH levels are associated with high success rates at assisted reproduction. Hum Reprod. 2009;24(11):2755–9.CrossRefPubMed Brodin T, Bergh T, Berglund L, Hadziosmanovic N, Holte J. High basal LH levels in combination with low basal FSH levels are associated with high success rates at assisted reproduction. Hum Reprod. 2009;24(11):2755–9.CrossRefPubMed
50.
go back to reference Lyu SW, Kim JW, Choi CH, Seok HH, Yoon TK, Kim A. Impact of high basal FSH/LH ratio in women with normal FSH levels on in vitro fertilization outcomes. Gynecol Endocrinol. 2013;29(5):424–9.CrossRefPubMed Lyu SW, Kim JW, Choi CH, Seok HH, Yoon TK, Kim A. Impact of high basal FSH/LH ratio in women with normal FSH levels on in vitro fertilization outcomes. Gynecol Endocrinol. 2013;29(5):424–9.CrossRefPubMed
51.
go back to reference Simoni M, Nieschlag E, Gromoll J. Isoforms and single nucleotide polymorphisms of the FSH receptor gene: implications for human reproduction. Hum Reprod Update. 2002;8(5):413–21.CrossRefPubMed Simoni M, Nieschlag E, Gromoll J. Isoforms and single nucleotide polymorphisms of the FSH receptor gene: implications for human reproduction. Hum Reprod Update. 2002;8(5):413–21.CrossRefPubMed
52.
go back to reference Perez Mayorga M, Gromoll J, Behre HM, Gassner C, Nieschlag E, Simoni M. ovarian response to follicle-stimulating hormone (FSH) stimulation depends on the FSH receptor genotype. J Clin Endocrinol Metab. 2000;85(9):3365–9.PubMed Perez Mayorga M, Gromoll J, Behre HM, Gassner C, Nieschlag E, Simoni M. ovarian response to follicle-stimulating hormone (FSH) stimulation depends on the FSH receptor genotype. J Clin Endocrinol Metab. 2000;85(9):3365–9.PubMed
53.
go back to reference de Koning CH, Benjamins T, Harms P, Homburg R, van Montfrans JM, Gromoll J, et al. The distribution of FSH receptor isoforms is related to basal FSH levels in subfertile women with normal menstrual cycles. Hum Reprod. 2006;21(2):443–6.CrossRefPubMed de Koning CH, Benjamins T, Harms P, Homburg R, van Montfrans JM, Gromoll J, et al. The distribution of FSH receptor isoforms is related to basal FSH levels in subfertile women with normal menstrual cycles. Hum Reprod. 2006;21(2):443–6.CrossRefPubMed
54.
go back to reference Sudo S, Kudo M, Wada S, Sato O, Hsueh AJ, Fujimoto S. Genetic and functional analyses of polymorphisms in the human FSH receptor gene. Mol Hum Reprod. 2002;8(10):893–9.CrossRefPubMed Sudo S, Kudo M, Wada S, Sato O, Hsueh AJ, Fujimoto S. Genetic and functional analyses of polymorphisms in the human FSH receptor gene. Mol Hum Reprod. 2002;8(10):893–9.CrossRefPubMed
55.
go back to reference Behre HM, Greb RR, Mempel A, Sonntag B, Kiesel L, Kaltwasser P, et al. significance of a common single nucleotide polymorphism in exon 10 of the follicle-stimulating hormone (FSH) receptor gene for the ovarian response to FSH: a pharmacogenetic approach to controlled ovarian hyperstimulation. Pharmacogenet Genomics. 2005;15(7):451–6.CrossRefPubMed Behre HM, Greb RR, Mempel A, Sonntag B, Kiesel L, Kaltwasser P, et al. significance of a common single nucleotide polymorphism in exon 10 of the follicle-stimulating hormone (FSH) receptor gene for the ovarian response to FSH: a pharmacogenetic approach to controlled ovarian hyperstimulation. Pharmacogenet Genomics. 2005;15(7):451–6.CrossRefPubMed
56.
go back to reference Lindgren I, Bååth M, Uvebrant K, Dejmek A, Kjaer L, Henic E, et al. Combined assessment of polymorphisms in the LHCGR and FSHR genes predict chance of pregnancy after in vitro fertilization. Hum Reprod. 2016;31(3):672–83.CrossRefPubMed Lindgren I, Bååth M, Uvebrant K, Dejmek A, Kjaer L, Henic E, et al. Combined assessment of polymorphisms in the LHCGR and FSHR genes predict chance of pregnancy after in vitro fertilization. Hum Reprod. 2016;31(3):672–83.CrossRefPubMed
Metadata
Title
Do young women with unexplained infertility show manifestations of decreased ovarian reserve?
Authors
Noa Abrahami
Ido Izhaki
Johnny S. Younis
Publication date
01-06-2019
Publisher
Springer US
Published in
Journal of Assisted Reproduction and Genetics / Issue 6/2019
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI
https://doi.org/10.1007/s10815-019-01467-0

Other articles of this Issue 6/2019

Journal of Assisted Reproduction and Genetics 6/2019 Go to the issue