Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Warwick Medical School, University of Warwick, Coventry, United Kingdom; University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
Fertil Steril. 2020 Apr;113(4):818-827.e3. doi: 10.1016/j.fertnstert.2019.11.014. Epub 2020 Mar 4.
To evaluate the association between diminished ovarian reserve (DOR) in women at risk of recurrent pregnancy loss (RPL) using ovarian reserve tests.
Systematic review and meta-analysis.
University medical schools.
PATIENT(S): Women with a history of RPL.
INTERVENTION(S): Systematic reviews of major electronic databases (MEDLINE, EMBASE, Web of Science, and Scopus) for studies that evaluated the incidence of DOR in women with RPL.
MAIN OUTCOME MEASURE(S): Association between RPL and DOR.
RESULT(S): In studies up to May 2019 we assessed quality using the Newcastle-Ottawa Scale and meta-analyzed data using a random-effect model. We included 15 studies (n = 3,082 women) reporting on six ovarian reserve tests: antimüllerian hormone [AMH], antral follicle count, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and FSH:LH ratio. More women with RPL seemed to have DOR compared with women who did not have RPL as measured by low AMH levels (odds ratio [OR] 2.77; 95% confidence interval [CI], 1.41-5.46) and AFC (OR 2.45; 95% CI, 1.16-5.19). Women with unexplained RPL also seemed to have a higher association with DOR compared with women whose RPL had a known etiology, as measured by low AMH levels (OR 3.23; 95% CI, 1.81-5.76). No statistically significant differences were found in the levels of any of the remaining ovarian reserve tests between those groups of women.
CONCLUSION(S): There is an apparent association between DOR and RPL. Low AMH and AFC levels could predict higher odds for pregnancy loss, but more studies are needed to evaluate their prognostic value in the management of women with RPL.
Prospero CRD42018114673.
通过卵巢储备试验评估有复发性妊娠丢失（RPL）风险的女性中卵巢储备减少（DOR）与 RPL 的相关性。
系统评价和荟萃分析。
大学医学院。
有 RPL 病史的女性。
系统检索主要电子数据库（MEDLINE、EMBASE、Web of Science 和 Scopus）中的研究，评估 RPL 女性 DOR 的发生率。
RPL 与 DOR 之间的关联。
截至 2019 年 5 月的研究中，我们使用纽卡斯尔-渥太华量表评估质量，并使用随机效应模型对数据进行荟萃分析。我们纳入了 15 项研究（n=3082 名女性），报告了 6 种卵巢储备试验的结果：抗苗勒管激素（AMH）、窦卵泡计数、卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇和 FSH：LH 比值。与没有 RPL 的女性相比，更多的 RPL 女性似乎存在 DOR，这表现为 AMH 水平较低（比值比[OR]2.77；95%置信区间[CI]1.41-5.46）和 AFC 较低（OR 2.45；95% CI 1.16-5.19）。与 RPL 病因已知的女性相比，不明原因 RPL 女性似乎与 DOR 的相关性更高，这表现为 AMH 水平较低（OR 3.23；95% CI 1.81-5.76）。在这些女性群体中，其余卵巢储备试验的水平之间没有发现统计学上的显著差异。
DOR 与 RPL 之间存在明显的关联。低 AMH 和 AFC 水平可能预示着妊娠丢失的几率更高，但需要更多的研究来评估它们在 RPL 女性管理中的预后价值。
Prospéro CRD42018114673。
