RESUMO
OBJECTIVE: To determine the association between antimüllerian hormone (AMH), a measure of ovarian reserve, and miscarriage among naturally conceived pregnancies. DESIGN: Prospective cohort study. SETTING: Not applicable. PATIENT(S): Women (n = 533), between 30 and 44 years of age with no known history of infertility, polycystic ovarian syndrome, or endometriosis who conceived naturally. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Miscarriage, defined as an intrauterine pregnancy loss before 20 weeks' gestation. RESULT(S): After adjusting for maternal age, race, history of recurrent miscarriage, and obesity, risk of miscarriage decreased as AMH increased (risk ratio per unit increase in natural log of AMH = 0.83; 95% confidence interval [CI], 0.73, 0.94). Women with severely diminished ovarian reserve (AMH ≤ 0.4 ng/mL) miscarried at over twice the rate of women with an AMH ≥ 1 ng/mL (hazard ratio, 2.3; 95% CI, 1.3, 4.3). CONCLUSION(S): AMH levels are inversely associated with the risk of miscarriage. Women with severely diminished ovarian reserve are at an increased risk of miscarriage.
Assuntos
Aborto Espontâneo/diagnóstico , Hormônio Antimülleriano/sangue , Biomarcadores/sangue , Aborto Espontâneo/sangue , Adulto , Hormônio Antimülleriano/análise , Estudos de Coortes , Feminino , Fertilização/fisiologia , Humanos , Gravidez , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue , Prognóstico , Fatores de RiscoRESUMO
OBJECTIVE: To determine the optimal criteria at which to start GnRH antagonists during controlled ovarian hyperstimulation (COH) for in vitro fertilization (IVF). DESIGN: Retrospective clinical cohort. SETTING: IVF clinics. PATIENT(S): Women undergoing fresh autologous IVF using GnRH antagonist for ovulation suppression during COH. INTERVENTION(S): Measurement of lead follicle size, E2 level, and cycle day of stimulation on day of antagonist initiation. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate (PR). RESULT(S): The highest clinical PR was achieved when the antagonist was started when a lead follicle reached 14-15.9 mm in size (mean clinical PR 21.3; 95% confidence interval [CI] 19.3, 23.6) on cycle day 6 (mean clinical PR 22.2; 95% CI 17, 28.4), or when the E2 level was between 500 and 599 pg/mL (mean clinical PR 25.4; 95% CI 19.5, 32.4). Starting antagonists when the E2 level was <300 or >1,100 pg/mL reduced the odds of clinical pregnancy by 40% (odds ratio 0.60, 95% CI 0.5, 0.7). CONCLUSION(S): Cycle day, E2 level, and follicle size at time of antagonist start are all independent predictors of a clinical pregnancy after IVF. Initiating antagonists when the E2 level is extremely low (<300 pg/mL) or extremely high (>1,100 pg/mL) significantly reduces the odds of pregnancy.