Diminished ovarian reserve associates with pregnancy and birth outcomes after IVF: a retrospective cohort study

Antral follicle count (AFC) and serum anti-Müllerian hormone (AMH) are currently the most sensitive and reliable markers of ovarian reserve, but the role of AFC and AMH, as prognosis markers of diminished ovarian reserve (DOR), in pregnancy outcomes after embryo transfer (ET) have been inconsistent. A retrospective cohort study was conducted in a university-affiliated hospital. A total of 4599 women who received their first IVF treatment between January 2012 and December 2019 were included. Uni- and multi-variable regression models were used to determine the association of DOR evaluated by AFC and AMH with pregnancy, number of ET cycles to pregnancy, live birth, preterm birth, and low birth weight. Among the women included, 380 (8.3%) had DOR (i.e. AFC <5 or AMH <1.2 μg/L). After adjusting for confounders, DOR determined by AFC/AMH, AFC alone and AMH alone was associated with a lower pregnancy rate (Risk ratio [RR] 0.81, 95% confidence interval [CI] 0.73-0.89). Among women who were successfully pregnant, DOR evaluated by AFC/AMH but not evaluated by AFC alone or AMH alone was associated with an increased number of ET cycles to pregnancy (Odds ratio 1.43, 95% CI 1.04-1.96). DOR was not associated with the risks of live birth, low birth weight, and preterm birth. Women with DOR may have more difficulty becoming pregnant after IVF treatment, suggesting the predictive role of DOR in pregnancy outcomes before IVF treatment.