Decreased Ovarian Reserve Predicts Inexplicability of Recurrent Miscarriage? A Retrospective Analysis.

Abstract

OBJECTIVE: To evaluate anti-Mullerian hormone, basal follicle stimulating hormone, luteinizing hormone, estradiol, and female age in women with recurrent miscarriage and to compare women with explained and idiopathic recurrent miscarriage. DESIGN: Retrospective cohort study. SETTING: University hospital, tertiary care center. PATIENTS: Women with recurrent miscarriage (78 explained, 66 idiopathic). INTERVENTION(S): None. MAIN OUTCOME MEASURES(S): Anti-Mullerian hormone, basal follicle stimulating hormone, luteinizing hormone, estradiol, and age. RESULTS: Anti-Mullerian hormone and estradiol were significantly lower in women with idiopathic recurrent miscarriage (median 1.2 ng/ml, IQR 0.6-2.1, and median 36.5 pg/ml, IQR 25.8-47.3, respectively) than in women with explained recurrent miscarriage (median 2.0 ng/ml, IQR 1.1-2.7, and median 42.5 pg/ml, IQR 32.8-59.8, respectively; p<0.05). Optimized cut-off values for the prediction of idiopathic recurrent miscarriage were <39.5 pg/ml for estradiol (sensitivity: 63.3%, 95% CI: 50.9-75.1; specificity: 56.4%, 95% CI: 44.7-67.6) and <1.90 ng/ml for anti-Mullerian hormone (sensitivity: 72.7%, 95% CI: 60.4-83.0; specificity: 52.6%, 95% CI: 40.9-64.0). CONCLUSION: Idiopathic recurrent miscarriage was associated with lower basal estradiol and anti-Mullerian hormone levels compared to explained recurrent miscarriage.