Department of Maternal and Child Health and Urology, Sapienza University, Viale Regina Elena, 324, 00161, Rome, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, ART Unit, Milan, Italy.
Arch Gynecol Obstet. 2024 Nov;310(5):2691-2696. doi: 10.1007/s00404-024-07741-6. Epub 2024 Sep 28.
There is several albeit not univocal evidence suggesting that ovarian reserve is not related to the chance of natural pregnancy, provided that the remnant follicular pool is sufficient to ensure regular menstrual cycles. Nevertheless, available studies have some methodological limitations, and the issue cannot be considered definitively ascertained.
To further address this issue, we retrospectively selected infertile women whose infertility diagnostic work-up was unremarkable (unexplained infertility-cases) and matched them by age and study period to a group of infertile women who were diagnosed with severe male infertility (controls). If ovarian reserve impacts on natural fertility, one had to expect lower ovarian reserve among women with unexplained infertility. Tested biomarkers included AMH, AFC and day 2-3 serum FSH. The primary aim was the frequency of women with serum AMH < 0.7 ng/ml.
Two-hundred fifty-two women with unexplained infertility and 252 women with male infertility were included. All biomarkers of ovarian reserve did not differ between the study groups. AMH levels < 0.7 ng/mL were observed in 26 (10%) women with unexplained infertility and 35 (14%) women with male infertility (p = 0.28). The adjusted OR was 0.76 (95% CI: 0.44-1.33). Significant differences did not also emerge when repeating this dichotomous analysis using other biomarkers and other thresholds for the definition of low-ovarian reserve.
This study confirms that ovarian reserve is unremarkable to natural conception. Physicians and patients should be aware of this concept to avoid inappropriate counseling and undue clinical decisions.
有一些证据表明，只要剩余的卵泡池足以确保规律的月经周期，卵巢储备与自然妊娠的机会无关。然而，现有研究存在一些方法学上的局限性，因此不能确定这个问题。
为了进一步解决这个问题，我们回顾性地选择了不孕诊断无明显异常的不孕妇女（不明原因不孕病例），并根据年龄和研究期间与一组被诊断为严重男性不育的不孕妇女（对照组）进行匹配。如果卵巢储备影响自然生育能力，那么人们必须预期不明原因不孕妇女的卵巢储备较低。测试的生物标志物包括 AMH、AFC 和第 2-3 天血清 FSH。主要目的是观察血清 AMH<0.7ng/ml 的女性频率。
纳入了 252 名不明原因不孕妇女和 252 名男性不育妇女。两组研究的所有卵巢储备生物标志物均无差异。不明原因不孕妇女中 AMH 水平<0.7ng/ml 的有 26 人（10%），男性不育妇女中 AMH 水平<0.7ng/ml 的有 35 人（14%）（p=0.28）。调整后的 OR 为 0.76（95%CI：0.44-1.33）。当使用其他生物标志物和其他低卵巢储备定义阈值重复这种二分分析时，也没有出现显著差异。
本研究证实卵巢储备对自然妊娠无明显影响。医生和患者应该意识到这一概念，以避免不适当的咨询和不必要的临床决策。
