Is Diminished Ovarian Reserve Associated with Poor Perinatal Outcomes? A Retrospective Cohort Study

ABSTRACT
Objective: To investigate whether diminished ovarian reserve (DOR) is associated with adverse perinatal outcomes in women undergoing intracytoplasmic sperm injection (ICSI) treatment.
Materials and Methods: This retrospective cohort study was performed in the In Vitro Fertilization (IVF) Unit of a hospital, examining records spanning from 2019 to 2022. The study involved 26 women diagnosed with DOR who achieved live births through ICSI. These patients were compared to a control group of 63 women who underwent IVF treatment due to male factor infertility, also resulting in live births. Outcomes analyzed included preterm birth (PTB), low birth weight (LBW), preterm premature rupture of membranes (PPROM), hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), abruptio placenta, intrahepatic cholestasis of pregnancy, congenital anomaly, c-section rate. The groups were matched by age and body mass index (BMI). Statistical analyses included logistic regression to evaluate the association between DOR and perinatal complications.
Results: Women with DOR demonstrated significantly poorer outcomes in several key areas. Birth weights were significantly lower in the DOR group compared to controls [2.300 (900–4.000) gr vs. 3.150 (900–4.100) gr, p = 0.011]. Additionally, the rate of PTB before 34 weeks was markedly higher in the DOR group (29.6% vs. 11.1%, p = 0.031), with an odds ratio of 3.36 (95% CI: 1.07–10.53), indicating a significantly elevated risk. PPROM was also notably more prevalent in the DOR group (25.9% vs. 7.9%, p = 0.021). In contrast, rates of HDP (14.8% vs. 12.7%, p = 0.787) and GDM (7.4% vs. 6.3%, p = 0.854) showed no significant differences. Other complications, including placental abruption, intrahepatic cholestasis, and congenital anomalies, were similar between the groups.
Conclusion: DOR is associated with increased risks of LBW, PTB, and PPROM. These findings emphasize the importance of tailored management for women with DOR to improve perinatal outcomes.
Keywords: Ovarian reserve, perinatal outcomes, intracytoplasmic sperm injection, low birth weight