Diminished ovarian reserve in recurrent pregnancy loss: a systematic review and meta-analysis

Our review of 15 studies suggests an association be- tween diminished ovarian reserve and recurrent pregnancy loss. There is a need to evaluate the best prognostic tools for diminished ovarian reserve.

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Volume 113, Issue 4, Pages 818–827.e3


Sarah J. Bunnewell, B.Sc., Emma R. Honess, B.Sc., Amar M. Karia, M.B.B.S., Stephen D. Keay, M.D., Bassel H. Al Wattar, Ph.D., Siobhan Quenby, Ph.D.



To evaluate the association between diminished ovarian reserve (DOR) in women at risk of recurrent pregnancy loss (RPL) using ovarian reserve tests.


Systematic review and meta-analysis.


University medical schools.


Women with a history of RPL.


Systematic reviews of major electronic databases (MEDLINE, EMBASE, Web of Science, and Scopus) for studies that evaluated the incidence of DOR in women with RPL.

Main Outcome Measure(s)

Association between RPL and DOR.


In studies up to May 2019 we assessed quality using the Newcastle-Ottawa Scale and meta-analyzed data using a random-effect model. We included 15 studies (n = 3,082 women) reporting on six ovarian reserve tests: antimüllerian hormone [AMH], antral follicle count, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and FSH:LH ratio. More women with RPL seemed to have DOR compared with women who did not have RPL as measured by low AMH levels (odds ratio [OR] 2.77; 95% confidence interval [CI], 1.41–5.46) and AFC (OR 2.45; 95% CI, 1.16–5.19). Women with unexplained RPL also seemed to have a higher association with DOR compared with women whose RPL had a known etiology, as measured by low AMH levels (OR 3.23; 95% CI, 1.81–5.76). No statistically significant differences were found in the levels of any of the remaining ovarian reserve tests between those groups of women.


There is an apparent association between DOR and RPL. Low AMH and AFC levels could predict higher odds for pregnancy loss, but more studies are needed to evaluate their prognostic value in the management of women with RPL.

Systematic Review Registration Number

Prospero CRD42018114673

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.