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Medicine Group Research Article Article ID: igmin188

A Study to Determine the Reason for Lower Pregnancy Rates in Younger Women with Diminished Oocyte Reserve-less Chance of Implanting vs. Fetal Demise

Gynecology Affiliation

Affiliation

    Cooper Medical School of Rowan University Camden, NJ, USA | Cooper Institute for Reproductive Hormonal Disorders, Mt Laurel, NJ, USA

    Cooper Medical School of Rowan University Camden, NJ, USA | Cooper Institute for Reproductive Hormonal Disorders, Mt Laurel, NJ, USA

    Inspira Health Network Vineland, NJ, USA

    Cooper Institute for Reproductive Hormonal Disorders, Mt Laurel, NJ, USA

    Cooper Medical School of Rowan University Camden, NJ, USA | Cooper Institute for Reproductive Hormonal Disorders, Mt Laurel, NJ, USA

Abstract

Most studies find lower live-delivered pregnancy rates (LDPRs) following in vitro fertilization-embryo transfer (IVF-ET) in women with diminished oocyte reserve (DOR) vs. normal oocyte reserve (NOR) even in a younger population. How much of a discrepancy may depend on the degree of oocyte depletion in the DOR group and the follicular stimulation protocol. Some fertility specialists favor an FSH receptor up-regulation technique as the protocol to attain the maximum LDPRs in women with DOR. The objective of this study was to compare chemical, clinical, and LDPRs following IVF-ET to determine if the main time of embryo loss is very early, as evidenced by the largest discrepancy occurring in attaining even a chemical pregnancy, and/ or a large discrepancy between a chemical pregnancy and attaining a clinical pregnancy (ultrasound evidence of a gestational sac) or later losses as evidenced by showing a greater loss rate from clinical evidence of pregnancy to live delivery in those with DOR compared to NOR. Overall, the DOR group, with a mean serum anti-Mullerian hormone (AMH) level of 0.42 ng/mL, had 50% as much chance to have an LDPR/transfer as women with NOR (AMH of 4.66) despite the same number of day 3 embryos transferred. The main reduction in LDPRs occurred from embryo transfer failing to attain a positive clinical pregnancy in the DOR group. The least discrepancy was from attaining a clinical pregnancy to live delivery. Thus, for NOR from positive pregnancy test 59% of this younger age group will have a live delivery vs. 50% for DOR. Thus, the reduction in LDPRS/transfer in young women with DOR vs. NOR seems mostly very early so the DOR group does not even attain a positive serum beta human chorionic gonadotropin level. This suggests that this inferiority in attaining a live delivery may be related to aneuploidy involving large chromosomes or a marked decrease in the mitochondrial DNA of the embryo.

References

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    2. Scott RT, Toner JP, Muasher SJ, Oehninger S, Robinson S, Rosenwaks Z. Follicle-stimulating hormone levels on cycle day 3 are predictive of in vitro fertilization outcome. Fertil Steril. 1989 Apr;51(4):651-4. doi: 10.1016/s0015-0282(16)60615-5. PMID: 2494082.
    3. Roberts JE, Spandorfer S, Fasouliotis SJ, Kashyap S, Rosenwaks Z. Taking a basal follicle-stimulating hormone history is essential before initiating in vitro fertilization. Fertil Steril. 2005 Jan;83(1):37-41. doi: 10.1016/j.fertnstert.2004.06.062. PMID: 15652884.
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