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

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. 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. Prospero CRD42018114673 Reserva ovárica disminuida en pérdida recurrente del embarazo: una revisión sistemática y metanálisis Evaluar la asociación entre la baja reserva ovárica (BRO) en mujeres con riesgo de pérdida recurrente del embarazo (recurrent pregancy loss: RPL) utilizando pruebas de reserva ovárica Revisión sistemática y metaanálisis. Universidades de medicina. Mujeres con historia de RPL. Revisiones sistemáticas de las principales bases de datos electrónicas (MEDLINE, EMBASE, Web of Science y Scopus) de estudios que evaluaron la incidencia de BRO en mujeres con RPL. Asociación entre RPL y BRO. En los estudios realizados hasta mayo de 2019, evaluamos la calidad utilizando la Escala de Newcastle-Ottawa y los datos meta-analizados mediante un modelo de efecto aleatorio. Se incluyeron 15 estudios (n = 3.082 mujeres) que informaron sobre seis pruebas de reserva ovárica: hormona antimulleriana [AMH], el recuento de folícu