A low number of retrieved oocytes at in vitro fertilization treatment is predictive of early menopause

Objective: To investigate whether women with a low number of retrieved oocytes at the first in vitro fertilization (IVF) attempt have an increased risk of early menopause. Design: Nested case-control study. Setting: Twelve IVF clinics in the Netherlands. Patient(s): Women participating in a nationwide Dutch cohort study (OMEGA) of ovarian stimulation for IVF and subsequent gynecologic diseases (n = 26,428). Each patient who experienced natural menopause at or before 46 years (n = 38) was individually matched to five controls (n = 190) who had not yet entered menopause at the age the patient became postmenopausal. Intervention(s): None. Main Outcome Measure(s): Relative risk of reaching natural menopause at an early age (≤46 years), according to the number of retrieved oocytes at the first IVF attempt. Result(s): Women with a poor response (zero to three oocytes) had a relative risk of 11.6 (95% confidence interval: 3.9–34.7) of having an early menopause as compared with women who have a normal response (> three oocytes). Women who were stimulated with gonadotropins during IVF treatment but did not undergo an IVF puncture because of an anticipated poor response (canceled IVF cycle) had a relative risk of 8.3 (95% confidence interval: 2.9–23.9). Conclusion: These results suggest that women with a low number of retrieved oocytes at the first IVF treatment are more likely to become postmenopausal at an early age than women with a higher number of retrieved oocytes. Our study is the first longitudinal study to provide strong evidence for the quantitative aspect of the ovarian concept of reproductive aging.