High incidence of diminished ovarian reserve in young unexplained recurrent pregnancy loss patients

Abstract

Recurrent pregnancy loss (RPL) is a clinically challenging scenario for patients and providers since an evidence-based approach to evaluation results in no explanation at least 50% of the time. The most common cause of first trimester clinical miscarriage is chromosome imbalance in the embryo or aneuploidy and the incidence of aneuploidy increases with age and diminished ovarian reserve (DOR). Currently, no professional societies recommend ovarian reserve testing in RPL patients, but some research shows a higher rate of DOR in miscarriage patients. The objective of this study was to evaluate the prevalence of DOR in unexplained vs. explained RPL patients. A prospective cohort study was completed, including 264 patients with recurrent pregnancy loss, 87 with an identifiable cause and 177 patients unexplained. A higher percentage of patients with unexplained RPL had DOR compared to patients with a known cause for RPL (48% vs 29%, p = .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 = .04). In conclusion, DOR is associated with RPL in many patients with otherwise unexplained RPL. Providers should consider adding ovarian reserve testing to their evaluation of RPL patients to guide counseling for treatment options.

摘要

反复妊娠丢失（RPL）对于患者和医生来说是一项挑战, 因为循证医学表明至少50%的RPL是不明原因的。早期流产最常见的原因是胚胎染色体不平衡或非整倍体, 非整倍体的发生率随着年龄的增长和卵巢储备(DOR)降低而增加。目前没有专业的学会推荐RPL的患者进行卵巢储备功能的检测, 但是一些研究表明在流产患者中DOR的比例高。本研究的目的是为了评估在不明原因vs.有原因RPL患者中DOR的患病率。进行了一项前瞻性队列研究, 纳入264例反复妊娠丢失的患者, 87例有明确原因的患者和177例不明原因的患者。与有明确原因的RPL患者相比, 不明原因PRL的患者中DOR的比例更高(48% vs 29%, p＝.005)。与38岁以上患者相比, 这一结论在小于38岁的患者中更明显（22% vs. 12%, p=.04）。结论：在许多不明原因的RPL患者中, DOR与RPL有关。医生应该考虑在RPL患者的检测评估中增加卵巢储备功能的检测, 以指导治疗方案。

Keywords:

• Recurrent pregnancy loss
• diminished ovarian reserve
• ovarian reserve testing
• miscarriage
• aneuploidy

Disclosure statement

No potential conflict of interest was reported by the author(s).