Recurrent pregnancy loss and diminished ovarian reserve

Objective: To determine the incidence of diminished ovarian reserve (OR) in patients with recurrent pregnancy loss (RPL). Design: Retrospective chart review. Setting: Tertiary fertility center. Patient(s): Six hundred ninety-two women undergoing a fertility evaluation. Intervention(s): Clomiphene citrate challenge test (CCCT). Main Outcome Measure(s): FSH concentrations measured on menstrual days 3 an d 10. Result(s): Forty-four women were diagnosed with RPL (+RPL), and 648 women h ad non-RPL diagnoses (-RPL). Compared with -RPL women, women with +RPL were younger (following statistics are listed as +RPL vs. -RPL, respectively; 3 4 +/- 5 vs. 35 +/- 4 y) but had similar menstrual cycle length (29 +/- 4 vs . 28 +/- 4 d), and lower day 3 FSH levels (8.9 +/- 7 vs. 11 +/- 9 mIU/mL) a nd similar day 10 FSH levels (11 +/- 8 vs. 12 +/- 11 mIU/mL). Eight of 44 w omen with +RPL (18%) had an abnormal CCCT, compared with 117/648 (18%) of w omen in the -RPL group. For women with normal OR, delivery rates were simil ar for -RPL and +RPL patients. For women with an abnormal CCCT, delivery ra tes were <5%. Conclusion(s): Women with RPL have a similar incidence of diminished OR as the general infertile population. Reproductive outcome for patients with an abnormal CCCT is equally poor for both groups. Ovarian reserve screening s hould be considered in the work-up of RPL before initiation of anticoagulan t or immunotherapy. (Fertil Steril(R) 2000;74:1192-5. (C) 2000 by American Society for Reproductive Medicine).