Despite advances in diagnostic modalities in the infertile couples, the cause of infertility remains largely unexplained in 25% to 30% of couples. The treatment in these couples remains largely empirical.
The result of a small study presented at the ACOG 2018 by, Dr. Andrea Starostanko MD and Dr. Jonathan Ayers MD from Saint Joseph Mercy Hospital Department of Obstetrics and Gynecology, Ann Arbor, MI suggests that even in young women with unexplained infertility (UI) ovarian reserve should be evaluated as part of initial work up.
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| Institute for Reproductive Health |
They looked
at data from 343 nulligravid couples (18-34 years) who were unable to conceive
after unprotected coitus for a period of 12 months. The couples underwent tubal
patency test, ovulation study and anatomic status by mid-cycle TVUS,
comprehensive semen analysis, and assessment of Decreased Ovarian Reserve (DOR)
with serum Anti-Mullerian Hormone (AMH).
A cause of infertility was found in 142/343 (41%) couples with anovulation in 30%, anatomic abnormality in 9% and male factor in 6%. In 201/343 (59%) of couples, no probable cause could be identified.
In these couples with UI, 118/201 women had serum AMH levels below the 95 percentile of age-appropriate value and in nearly 25% of women below the age of 35(53/201), the values were < 1.5.
The researchers concluded that:
All women with UI should be investigated for ovarian reserve during the initial workup, irrespective of their age
Women who are diagnosed with DOR should seek consultation with a specialist for further treatment options
DOR may also be a harbinger of premature menopause and associated cardiovascular complications
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