Does Adjuvant Letrozole During Ovarian Stimulation for Ivf Reduce the Need for Luteal Support? A Randomized Controlled Trial

Abstract

OBJECTIVE: To evaluate whether diminished ovarian reserve (DOR) and its etiology impact the AMH/AFC ratio?MATERIALS AND METHODS: From November 2018 to December 2021, we conducted a monocentric, retrospective study including a total of 484 infertile patients <37 years with DOR. All patients underwent measurement of AMH levels and AFC. DOR was diagnosed according to the Bologna criteria (AMH<1.1 ng/mL and AFC<7). AMH/AFC ratio was compared to values obtained in 154 tubal or male infertility patients matched for age and BMI, with AMH and AFC in the normal ranges. This ratio was studied according to the etiology of DOR: genetic (n¼26), post-chemotherapy (n¼102), idiopathic (n¼215) or ovarian diseases (ovarian cyst or history of ovarian surgery, n¼141).RESULTS: Overall, median age of women with DOR was 30 (18-37) years. As expected, age and BMI were comparable in women with DOR and those having normal ovarian reserve tests. In addition, the AMH/AFC ratio failed to show any difference between these 2 groups (0.143 AE 0.22 vs. 0.166 AE 0.11, NS, respectively). Among women with DOR, the etiology was significantly associated with different AMH/AFC ratio. Indeed, patient with DOR of surgical origin (ovarian diseases group) displayed higher mean values (0.283 AE 0.32 ng/mL/ Foll) when compared with those included in genetic (0.079 AE 0.15 ng/mL/ Foll, p<0.01), idiopathic (0.103 AE 0.16 ng/ mL/ Foll, p<0.03) or post-chemotherapy (0.084 AE 0.20 ng/mL/ Foll, p<0.01) groups. Moreover, genetic and post-chemotherapy DOR was also associated with lower AMH/AFC ratio in comparison with idiopathic DOR.CONCLUSIONS: AMH/AFC ratio varies according to the etiology of DOR in young women, suggesting different impact on the follicular health, and further oocyte quality.IMPACT STATEMENT: AMH/AFC ratio may represent an innovative tool aiming to indirectly assess follicular health and possibly oocyte quality in young women with DOR. The etiology of DOR differently impacts the follicular function as reflected by AMH/AFC ratio. Further data on live birth rates following natural or medically assisted pregnancies is needed.