Should a history of pregnancy loss call for an assessment of the ovarian reserve in women 35 years of age or younger?

Abstract

Research question: Is a history of pregnancy loss correlated with low age-adapted ovarian reserve in women aged 35 years or younger? Design: This was a retrospective cohort study. Results: A total of 931 women aged 35 years or less with anti-Mu<euro>llerian-hormone (AMH) values measured at presentation to a fertility centre were included in the analysis. The pregnancy loss rate, modelled as pregnancy loss count per previous pregnancy, increased at both ends of the age-normalized AMH z-score, showing a statistically significant increase (odds ratio 0.49, 95% confidence interval 0.25-0.94; P = 0.032) at the lower end (z-score lower than -1.28, 10th percentile) of AMH values. Conclusions: Women aged 35 years or less are assumed to have a low risk of aneuploidy as a cause of pregnancy loss. While the association between low ovarian reserve and pregnancy loss in this group is still debated, the findings presented describe a significant association between a history of pregnancy loss in women of 35 years or less and an age-adjusted low ovarian reserve. This calls for assessment of the ovarian reserve in women with pregnancy losses, as an early diagnosis of low ovarian reserve may have far-reaching implications for fertility counselling, especially in an era when women often postpone childbearing.