Wald KA1, Shahine LK2*, Lamb JD2, Marshall LA2 and Hickok LR2
1Department of Obstetrics and Gynaecology, University of California San Francisco, USA
2Pacific Northwest Fertility and IVF Specialists, USA
Objective: To evaluate the prevalence of Diminished Ovarian Reserve (DOR) in unexplained Recurrent Pregnancy Loss (RPL) patients.
Methods: Prospective cohort study including 264 patients with recurrent pregnancy loss, 87 with an identifiable cause and 177 patients with unexplained RPL, undergoing evaluation for at a University-affiliated private IVF clinic between January 1, 2011 and August 1, 2015.
Results: Of the 264 patients with recurrent pregnancy loss, 33% (N=87) had an identifiable cause for RPL after the ASRM-recommended evaluation was completed. The remaining 177 patients were considered to have unexplained RPL. A higher percentage of patients with unexplained RPL had DOR compared to patients with a known cause for RPL (48% vs. 29%, P=0.005). This finding was most significant in patients less than 38 years old compared to patients 38 years old and older (22% vs. 12%, P=0.02).
Conclusion: Diminished ovarian reserve is associated with RPL in many patients with otherwise unexplained RPL. This relationship may be explained by the high risk of aneuploidy miscarriage with DOR. This association of DOR with unexplained RPL is strongest in patients less than 38 years old. Providers should consider adding ovarian reserve testing to their evaluation of RPL patients to guide counseling for treatment options
Wald KA, Shahine LK, Lamb JD, Marshall LA, Hickok LR. Diminished Ovarian Reserve May Explain Otherwise Unexplained Recurrent Pregnancy Loss. Ann Pregnancy Birth. 2018; 1(1): 1005.