Is ovarian reserve associated with an increased risk of miscarriage? A systematic review and meta-analysis

This review determines the association between ovarian reserve markers, anti-Müllerian hormone (AMH) and antral follicle count (AFC), with risk of miscarriage in women undergoing assisted reproductive technology. A systematic search of PubMed, Embase, Cochrane Library and Google Scholar from inception to September 2023 identified 16 retrospective studies, including 43,147 patients. A meta-analysis using a random effects model demonstrated that low AMH concentration is associated with a significantly increased risk of miscarriage compared with medium and high AMH concentration (OR 1.48, 95% CI 1.20 to 1.83, P = 0.0002). When stratified by age, the risk remained significant in women aged younger than 35 years (OR 1.34, 95% CI 1.17 to 1.54, P < 0.0001); however, results were not significant among women aged 35 years or younger (OR 1.29, 95% CI 0.95 to 1.76, P = 0.10). Similarly, low AFC was associated with an increased risk of miscarriage across all ages (OR 1.80, 95% CI 1.33 to 2.45, P = 0.0002). After age adjustment, the association was significant in women aged younger than 35 years (OR 1.61, 95% CI 1.20 to 2.16, P = 0.002), but not among women aged 35 years or older (OR 1.41, 95% CI 0.90 to 2.22, P = 0.14). Therefore, a reduced ovarian reserve is associated with an increased risk of miscarriage, although results are only significant among women aged younger than 35 years.