Diminished ovarian reserve: is it a neglected cause in the assessment of recurrent miscarriage? A cohort study

Objective: To study whether diminished ovarian reserve is associated with recurrent miscarriage. Design: Cross-sectional clinical study. Setting: Tertiary-care center. Patient(s): Women with history of recurrent miscarriage (RM; n = 71) and sequentially selected age-matched fertile women who were seeking contraception (control; n = 70). Intervention(s): Not applicable. Main Outcome Measures(s): Serum levels of FSH, LH, E-2, and antimullerian hormone (AMH); FSH/LH ratio; ovarian volumes; and antral follicle count (AFC). Result(s): The levels of FSH were 8.6 +/- 3.7 U/L in the RM group and 7.1 +/- 3.9 U/L in the control group; this difference was statistically significant. The levels of AMH were significantly lower in the RM group than in the control group (2.9 +/- 1.7 ng/mL vs. 3.6 +/- 1.7 ng/mL). The percentage of women with levels of FSH >= 11 U/L was significantly higher in the RM group than in the control group (18.3% vs. 4.3%). In the RM group, the percentage of women with levels of AMH <= 1 ng/mL was significantly higher than in the control group (19.7% vs. 5.7%). Conclusion(s): Recurrent miscarriage may be associated with diminished ovarian reserve. Larger prospective randomized controlled trials are warranted to better determine the predictive potential of ovarian reserve markers in recurrent miscarriage. (C) 2016 by American Society for Reproductive Medicine.)