The likelihood of achieving pregnancy through timed coitus in young infertile women with decreased ovarian reserve

Objective: To evaluate the pregnancy rate and time to pregnancy after timed coitus with or without superovulation in infertile young women younger than 35 years old with low serum anti-Mullerian hormone (AMH) levels (< 25th percentile). Methods: A total of 202 patients younger than 35 years old were recruited retrospectively between 2010 and 2012. Ninety-eight women had normal serum AMH levels (25-75th percentile), 75 women had low serum AMH levels (5th <=&<25th percentile) and 29 women had very low serum AMH levels (< 5th percentile), according to reference values for their age group. Results: The clinical pregnancy rate was positively associated with AMH levels, but this trend did not reach statistical significance (43.9% vs. 41.3% vs. 27.6% in the normal, low, and very low AMH groups, respectively). The time to pregnancy was longer in the very low AMH group than in the normal AMH group (13.1 +/- 10.9 months vs. 6.9 +/- 6.1 months, p=0.030). The cumulative live birth rate over 18 months was lower in the very low AMH group than in the normal AMH group, with marginal significance (20.0% vs. 55.9%, p=0.051). The duration of infertility was negatively correlated with achieving pregnancy (odds ratio, 0.953; 95% confidence interval, 0.914-0.994; p=0.026). Conclusion: Conservative management, such as timed coitus with or without superovulation, should be considered in young patients who have low ovarian reserve without any infertility factors. However, for women with a long duration of infertility or very low serum AMH levels, active infertility treatment should be considered.