Fecundity disorders in older women: declines in follicular development and endometrial receptivity

Abstract

Background : Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women. Methods: For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women. Results: The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women ( p = 0.019, p = 0.022 respectively). The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller ( p =0.041, p =0.032, p =0.025 respectively), and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women ( p =0.046, p =0.039, p =0.036, p =0.035 respectively). The normal ovulation rate was significantly lower in older women than in young women ( p =0.001). The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women ( p =0.041, p =0.019, p =0.015, p =0.007 respectively). The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women ( p =0.012, p =0.003, p =0.001 respectively). The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%). Conclusions: Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.

Clinical outcomes after elective double-embryo transfer in frozen cycles for women of advanced maternal age

“…[8,9] Decreased ovarian function not only affects the quantity and quality of oocytes and embryos, [10] but it also may impair endometrial receptivity. [11] Decreased ovarian reserve and endometrial injury caused by abortion and endometritis after delivery may also explain reduced endometrial receptivity. Some studies have reported that the pregnancy rate and LBR of patients over 40 years old with frozen embryo transfer have increased significantly.…”

“…The main reasons for the age-related decrease in oocyte and embryo quantity and quality include increased chromosomal abnormalities and apoptosis in oocytes, decreased mitochondrial number impacting function, and insufficient energy supply eventually leading to reduced oocyte number and viability [8,9] . Decreased ovarian function not only affects the quantity and quality of oocytes and embryos, [10] but it also may impair endometrial receptivity [11] . Decreased ovarian reserve and endometrial injury caused by abortion and endometritis after delivery may also explain reduced endometrial receptivity.…”

Artificial Intelligence in the Assessment of Female Reproductive Function Using Ultrasound: A Review

“…However, there are many factors which are correlated with the success rate of pregnancy (including age, environment, endocrine level, ovarian reserve, endometrial receptivity, etc. ), and the pregnancy results are always caused by various factors 3–5 . The important role of ultrasound in female reproductive function is evaluation of ovarian reserve (OR) and endometrial receptivity (ER) 6 .…”

“…), and the pregnancy results are always caused by various factors. [3][4][5] The important role of ultrasound in female reproductive function is evaluation of ovarian reserve (OR) and endometrial receptivity (ER). 6 In the assessment of OR, serial ultrasound examinations can provide reliable markers to follicular monitoring, the diagnosis of Polycystic Ovary Syndrome (PCOS), and prediction of oocyte quality and pregnancy outcomes, such as ovarian follicular diameter and volume, number of follicles, ovarian stromal blood flow index, etc.…”