Implications of diminished ovarian reserve (DOR) extend well beyond reproductive concerns

Objectives: To investigate whether a diagnosis of diminished ovarian reserve (DOR) in premenopausal years has adverse implications for skeletal health and quality of life. Design: This was a cross-sectional Study of infertile, albeit healthy, mid-reproductive-age Nvornen (younger than 42 y) attending ail academic infertility practice. Results: Eighty-nine women with varying causes of infertility were prospectively enrolled. Serum (cycle d 1-3) was collected for markers of ovarian reserve, bone metabolism, testosterone, and free androgen index. Bone mineral density (BMD) was assessed and categorized as low if the Z score was less than - 1.0). Infertile women with DOR (n = 28) demonstrated significantly higher serum follicle-stimulating hormone levels (P < 0.001), lower mullerian-inhibiting substance (MIS) levels (P < 0.001), smaller ovarian dimensions (P < 0.05). lower testosterone levels (P = 0.035). lower free androgen index (P = 0.019), and enhanced bone metabolism (P = 0.003); although the prevalence of low BMD was higher in women with DOR who were younger than 41. this relationship was not of statistical significance (P = 0.106). Women Younger than 41 years of age with DOR were significantly more likely to manifest disturbed sleep (P 0.049) and acknowledge dissatisfaction with sexual intimacy (P - 0.004) compared with those with infertility and normal ovarian reserve. After adjustment for potential confounders, a diagnosis of DOR was significantly associated with low BMD, increased bone turnover, sexual dissatisfaction, and disturbed sleep. Conclusions: Our data suggest that DOR unmasked in the context of infertility evaluation has adverse implication, for a woman's well-being that extend well beyond the thus far appreciated reproductive concerns. A decline in ovarian hormones, specifically estrogen and testosterone. concomitant with DOR may be hypothesized as a mechanism that can explain the observed multisystem ramifications of DOR including increased bone turnover, low BMD, Sexual distress, and disturbed sleep.