Ovarian reserve testing in the prediction of recurrent pregnancy loss

Yıl 2020, , 25 - 28, 02.01.2020

Sadik Kükrer , Sefa Arlıer , Seyfettin Karaman

https://doi.org/10.28982/josam.670091

Öz

Aim: Approximately 1-2% of reproductive women have faced recurrent pregnancy loss (RPL). Ovarian reserve testing in the prediction of recurrent pregnancy loss is not usually performed. In this study, we aim to evaluate whether there were any differences between patients with and without a history of recurrent pregnancy loss (RPL) with regards to anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (Lh), estradiol (E2) levels and basal follicle count.

Methods: This case-control study was conducted between 1 January 2013 and 1 January 2015 in the Gynecology and Obstetrics Clinic of Adana Numune Training and Research Hospital. A total of 370 patients aged 17-37 years with a diagnosis of RPL during that 2-year period were contacted by telephone. Further evaluation was made of 40 patients who met the study criteria and gave verbal consent. Patients were called to the Gynecology Polyclinic for assessment on the 3rd day of their menstrual cycle, and a control group was formed of 40 patients with similar demographic characteristics who were referred to the Gynecology Polyclinic and met the study criteria. 

Results: The mean basal follicle count was determined as 9.4 (2.7) in the study group and 8.9 (2.5) in the control group (P=0.092). The mean AMH values in the RPL and control groups were 3.50 (1.92) ng/mL and 3.66 (2.14) ng/mL, respectively (P=0.718). The mean FSH values in the RPL and control groups were 6.77 (1.87) mIU/mL and 7.01 (1.90) mIU/mL, respectively (P=0.494). Mean LH values were measured as 5.6 (1.8) mIU/mL in the study group and 4.9 (1.7) mIU/mL in the control group. Mean E2 values were 87.7 (83.9) pg/mL and 48.4 (27.9) pg/mL in the study and control groups, respectively.

Conclusion: While no difference was found between the RPL and control groups in respect of AMH and FSH values in the ovarian reserve tests, the basal follicle count of the patients with recurrent pregnancy loss was found lower than that of the control group.

Anahtar Kelimeler

Recurrent pregnancy loss, Ovarian reserve, AMH, Basal follicle count, FSH

Teşekkür

The authors thank Ümit Ali Kayışlı for his contribution to this research

Tekrarlayan gebelik kaybını öngörmede over rezerv testlerinin kullanılması

Öz

Amaç: Üreme çağındaki kadınlarının yaklaşık %1-2'si tekrarlayan gebelik kaybı (RPL) ile karşı karşıyadır. Tekrarlayan gebelik kaybının öngörülmesinde yumurtalık rezerv testi genellikle yapılmaz. Bu çalışmamızda Antimüllerian hormon, follikül stimulant hormon, Lüteinizan hormon, Estradiol ve Bazal follikül sayısının tekrarlayan gebelik kabı olan ve olmayan hastalar arasında farklı olup olmadığının değerlendirilmesi amaçlanmıştır.

Yöntemler: 2 yıllık sürede tekrarlayan gebelik kaybı tanısı konulan, yaşları 17-37 yaş arası 370 hasta telefonla aranarak ayrıntılı sorgulama sonucu çalışma kriterlerine uyan ve sözlü onamları alınan 40 hasta tekrar değerlendirilmek üzere mensrüel siklusun 3. günü jinekoloji polikiniğe davet edildi. Çalışma grubu olarak alınan hastalarla aynı gün jinekoloji polikliniğine başvuran benzer demoğrafik özellikteki çalışma kriterlerine uyan 40 hasta kontrol grubu olarak oluşturuldu.

Bulgular: Tekrarlayan gebelik kaybı olan grupta ortalama bazal follikül sayısı 9,4 (2,7) adet, kontrol grubunda 8,9 (2,5) adet olarak ölçüldü. (P=0,092). Tekrarlayan gebelik kaybı olan grupta ortalama AMH değeri 3,50 (1.92) ng/mL, kontrol grubunda 3,66 (2,14) ng/mL, (P=0,718), FSH değeri tekrarlayan düşük yapan grupta 6,77 (1,87) mIU/mL, kontrol grubunda 7,01 (1,29) mIU/mL (P=0,494), LH değeri sırasıyla 5,6 (1,8) mIU/mL ve 4,9 (1,7) mIU/mL, E2 değeri sırasıyla 87,7 (83,9) pg/mL, 48,4 (27,9) pg/mL olarak ölçüldü.

Sonuç: Over rezevr testlerinden tekrarlayan gebelik kaybı olan grup ile kontrol grubu arasında AMH, FSH değerleri arasında fark bulunmazken, tekrarlayan gebelik kaybı olan grupta estradiol seviyesi daha yüksek, bazal follikül sayısı ise daha düşük bulundu.

Anahtar Kelimeler

Tekrarlayan gebelik kaybı, Over rezervi, AMH, Bazal follikül sayısı, FSH

Kaynakça

• 1. Jauniaux E, Farquharson RG, Christiansen OB, Exalto N. Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage. Hum Reprod. 2006;21:2216-22.
• 2. Ford HB, Schust DJ. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol. 2009;2:76-83.
• 3. Vigier B, Picard JY, Tran D, Legeai L, Josso N. Production of anti-Mullerian hormone: another homology between Sertoli and granulosa cells. Endocrinology. 1984;114:1315-20.
• 4. Nardo LG, Gelbaya TA, Wilkinson H, Roberts SA, Yates A, Pemberton P, et al. Circulating basal anti-Mullerian hormone levels as predictor of ovarian response in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril. 2009;92:1586-93.
• 5. Grol R. Personal paper. Beliefs and evidence in changing clinical practice. BMJ. 1997;315:418-21.
• 6. van den Boogaard E, Goddijn M, Leschot NJ, Veen F, Kremer JA, Hermens RP. Development of guideline-based quality indicators for recurrent miscarriage. Reprod Biomed Online. 2010;20:267-73.
• 7. McCormack CD, Leemaqz SY, Furness DL, Dekker GA, Roberts CT. Anti-Mullerian hormone levels in recurrent embryonic miscarriage patients are frequently abnormal, and may affect pregnancy outcomes. J Obstet Gynaecol. 2019;39:623-7.
• 8. Jiang X, Yan J, Sheng Y, Sun M, Cui L, Chen ZJ. Low anti-Mullerian hormone concentration is associated with increased risk of embryonic aneuploidy in women of advanced age. Reprod Biomed Online. 2018;37:178-83.
• 9. Lin PY, Huang FJ, Kung FT, Chiang HJ, Lin YJ, Lin YC, et al. Evaluation of serum anti-Mullerian hormone as a biomarker of early ovarian aging in young women undergoing IVF/ICSI cycle. Int J Clin Exp Pathol. 2014;7:6245-53.
• 10. Murugappan G, Shahine L, Lathi RB. Antimullerian hormone is a predictor of live birth in patients with recurrent pregnancy loss. Fertil Res Pract. 2019;5:2.
• 11. McCormack CD, Leemaqz SY, Furness DL, Dekker GA, Roberts CT. Anti-Mullerian hormone levels in recurrent embryonic miscarriage patients are frequently abnormal, and may affect pregnancy outcomes. J Obstet Gynaecol. 2019;39:623-7.
• 12. Lyttle Schumacher BM, Jukic AMZ, Steiner AZ. Antimullerian hormone as a risk factor for miscarriage in naturally conceived pregnancies. Fertil Steril. 2018;109:1065-71 e1.
• 13. Hongdong L, Guini H, Zheng G. Age-related DNA methylation changes in peripheral whole blood. Yi Chuan. 2015;37:165-73.
• 14. Tremellen K, Zander-Fox D. Serum anti-Mullerian hormone assessment of ovarian reserve and polycystic ovary syndrome status over the reproductive lifespan. Aust N Z J Obstet Gynaecol. 2015;55:384-9.
• 15. Chang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mullerian hormone levels. Fertil Steril. 2010;94:343-9.
• 16. Garrido-Gimenez C, Alijotas-Reig J. Recurrent miscarriage: causes, evaluation and management. Postgrad Med J. 2015;91:151-62.
• 17. Qiu Q, Yang M, Tsang BK, Gruslin A. Fas ligand expression by maternal decidual cells is negatively correlated with the abundance of leukocytes present at the maternal-fetal interface. J Reprod Immunol. 2005;65:121-32.
• 18. Liu Z, Sun QH, Yang Y, Liu JM, Peng JP. Effect of IFNgamma on caspase-3, Bcl-2 and Bax expression, and apoptosis in rabbit placenta. Cytokine. 2003;24:201-9.
• 19. Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM. The predictive accuracy of anti-Mullerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature. Hum Reprod Update. 2014;20:560-70.
• 20. Lyttle Schumacher BM, Jukic AMZ, Steiner AZ. Antimullerian hormone as a risk factor for miscarriage in naturally conceived pregnancies. Fertil Steril. 2018;109:1065-71 e1.
• 21. Barbakadze L, Kristesashvili J, Khonelidze N, Tsagareishvili G. The correlations of anti-mullerian hormone, follicle-stimulating hormone and antral follicle count in different age groups of infertile women. Int J Fertil Steril. 2015;8:393-8.
• 22. Yuan X, Lin HY, Wang Q, Li TC. Is premature ovarian ageing a cause of unexplained recurrent miscarriage? J Obstet Gynaecol. 2012;32:464-6.
• 23. Remohi J, Gallardo E, Levy M, Valbuena D, de los Santos MJ, Simon C, et al. Oocyte donation in women with recurrent pregnancy loss. Hum Reprod. 1996;11:2048-51.
• 24. Robinson L, Gallos ID, Conner SJ, Rajkhowa M, Miller D, Lewis S, et al. The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Hum Reprod. 2012;27:2908-17.
• 25. Jiang X, Yan J, Sheng Y, Sun M, Cui L, Chen ZJ. Low anti-Mullerian hormone concentration is associated with increased risk of embryonic aneuploidy in women of advanced age. Reprod Biomed Online. 2018;37:178-83.
• 26. Plante BJ, Beamon C, Schmitt CL, Moldenhauer JS, Steiner AZ. Maternal antimullerian hormone levels do not predict fetal aneuploidy. J Assist Reprod Genet. 2010;27:409-14.
• 27. Murugappan G, Shahine L, Lathi RB. Antimullerian hormone is a predictor of live birth in patients with recurrent pregnancy loss. Fertil Res Pract. 2019;5:2.
• 28. Chang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mullerian hormone levels. Fertil Steril. 2010;94:343-9