Fertility preservation in women with diminished ovarian reserve: evaluating the AMH criteria

Does fertility preservation (FP) through oocyte cryopreservation provide realistic reproductive opportunities for diminished ovarian reserve (DOR)? Literature suggests cumulative live birth rates of 30-45% with 8-10 oocytes under 35 years old. Insufficient data exist to define whether DOR patients should be offered FP systematically.

This retrospective single-center study analyzed data from 304 women undergoing oocyte cryopreservation (January 2016-December 2024). Patients were stratified into cohort 1 (Anti-Müllerian hormone-AMH-≤ 0.5 ng/mL, n = 49) and cohort 2 (AMH > 0.5 ng/mL, n = 255). Primary outcomes included retrieved oocytes (RO) and vitrified oocytes (VO). Secondary outcome examined DuoStim results. Statistical analysis included correlation assessments, ANCOVA, and multiple linear regression.

DOR patients achieved lower oocyte yields compared to cohort 2 (RO: 3.1 ± 2.3 vs. 9.0 ± 6.5; VO: 2.3 ± 1.9 vs. 7.4 ± 5.1; p < 0.001), despite higher gonadotropin doses. AMH strongly correlated with RO (ρ = 0.636, p < 0.001) and VO (ρ = 0.624, p < 0.001). Linear regression confirmed AMH (B = 1.151, p < 0.001) and age (B =  - 0.139, p = 0.002) as significant predictors of VO. In DuoStim subgroup, DOR patients achieved 3.3 ± 2.1 total VO compared to 6.9 ± 3.3 in cohort 2 (p = 0.001).

DOR patients achieve oocyte yields substantially below thresholds associated with reasonable live birth rates, raising concerns regarding FP efficacy. These findings highlight the need for personalized counseling that considers individual patient characteristics and provides evidence-based, realistic expectations for FP. A revision of current AMH thresholds may improve patient selection and cost-effectiveness of FP programs. Younger DOR patients may benefit from oocyte cryopreservation for FP, emphasizing the importance of age stratification.