The Correlation Between Female Age and Ovarian Reserve Biomarkers (FSH & AMH) and Its' Effect on The Response to Controlled Ovarian Hyper-stimulation (COS) and Pregnancy Rate Following Intracytoplasm sperm injection ( ICSI )

INTRODUCTION: This study aimed to assess the association between female age, ovarian reserve biomarkers, response to controlled ovarian stimulation represented by the dose of gonadotropin stimulation, number and quality of retrieved oocytes, cycle cancellation rate and pregnancy rate in those who undergo ICSI.
METHODS: A total of 126 couples complained of sub-fertility have been evaluated and subjected to COS/ICSI and divided into two groups below and above 35 years old. Assessment of cycle day 2 FSH and AMH, response to COS, cycle cancellation rate, and the pregnancy rate has been performed, and the results compared between both.
RESULTS: The study showed that baseline serum level of FSH and AMH did not differ between groups. Women older than 35 years old needed significantly higher doses of gonadotropin stimulation(mean total dose of r-FSH 2179.4±1222.2 vs 1987.2±947.6, p-value=0.036 and mean total dose of HMG 3122.3±1456.8 vs 2468.7±1454.8, p-value=0.02), produced significantly lower number of oocytes (6.09±4.7 vs 9.8±6.4,p-value=0.0001), and mature oocytes (4.4±3.8 vs 6.7±5.1,p-value=0.005), higher rate of cycle cancellation(17.7% vs 4.6%) and insignificantly lower pregnancy rate(23.5% vs 37.7%, p-value=0.107) following ICSI in comparison with those younger than 35 years old.
DISCUSSION AND CONCLUSION: Age is a significant determinant factor that affects the ovarian reserve, can lead to ovarian aging, and lower the women's fertility rate. Older women exhibit a low response to ovarian stimulation with a higher cancellation rate, produce a small number of oocytes with low quality following COS despite their higher need for large doses of gonadotropin stimulation.