The Correlation Between Female Age and Ovarian Reserve Biomarkers (FSH & AMH) and Its' Effect on The Response to Controlled Ovarian Hyper-stimulation (COS) and Pregnancy Rate Following Intracytoplasm sperm injection ( ICSI )

Abstract

Several methods are developing to assess the biological and functional age of women ovary. Since ovarian reserve (OR) may change over time, limited ovarian reserve needs further tests to be confirmed. The likelihood of sub -fertility treatment success is highly dependent on the women’s age. With advanced age, the likelihood of having a child decreases significantly making those women in high need of assisted conception. The study aimed to assess the association between female age, ovarian reserve biomarkers (follicular stimulating hormone and anti-mullerian hormone), response to controlled ovarian stimulation (COS) represented by the dose of gonadotropin stimulation, number and quality of retrieved oocytes, cycle cancellation rate and pregnancy rate in thos e who undergo ICSI. One hundred twenty six couples complained of sub-fertility collected from Al-Kafeel Fertility and IVF Center/ Holy Kerbala/ Iraq throughout a period between 2016-2019. These couples have been evaluated and subjected to COS/ICSI and divided into two groups below and above 35 years old. Assessment of cycle day 2 FSH and AMH, response to COS, cycle cancellation rate, and the pregnancy rate has been performed, and the results compared between both. The study showed that baseline serum level of FSH and AMH did not differ between women older and younger than 35 years old (in younger women, mean serum FSH 6.6±4.0 and AMH 2.4±1.8 vs 7.7±4.3 and 2.2±2.8 respectively in older ones, p-value=0.15). Women older than 35 years old needed significantly higher doses of gonadotropin stimulation(mean total dose of r-FSH 2179.4±1222.2 vs 1987.2±947.6, p-value=0.036 and mean total dose of HMG 3122.3±1456.8 vs 2468.7±1454.8, p-value=0.02), produced significantly lower number of oocytes (6.09±4.7 vs 9.8±6.4,p-value=0.0001), lower number of mature oocytes (4.4±3.8 vs 6.7±5.1,p-value=0.005), higher rate of cycle cancellation(17.7% vs 4.6%) and insignificantly lower pregnancy rate(23.5% vs 37.7%, p-value=0.107) following ICSI in comparison with those younger than 35 years old. Age is a significant determinant factor that affects the ovarian reserve, can lead to ovarian aging, and lower the women’s fertility rate. There is a weak correlation between age, FSH, and AMH levels. Older women exhibit a low response to ovarian stimulation with a higher cancellation rate, produce a small number of oocytes with low quality following COS despite their higher need for large doses of gonadotropin stimulation. The pregnancy rate is affected by advanced women’s age following ICSI.