Implications of diminished ovarian reserve (DOR) extend well beyond reproductive concerns

Menopause. 2008 Nov-Dec;15(6):1086-94. doi: 10.1097/gme.0b013e3181728467.

Abstract

Objectives: To investigate whether a diagnosis of diminished ovarian reserve (DOR) in premenopausal years has adverse implications for skeletal health and quality of life.

Design: This was a cross-sectional study of infertile, albeit healthy, mid-reproductive-age women (younger than 42 y) attending an academic infertility practice.

Results: Eighty-nine women with varying causes of infertility were prospectively enrolled. Serum (cycle d 1-3) was collected for markers of ovarian reserve, bone metabolism, testosterone, and free androgen index. Bone mineral density (BMD) was assessed and categorized as low if the Z score was less than -1.0). Infertile women with DOR (n = 28) demonstrated significantly higher serum follicle-stimulating hormone levels (P < 0.001), lower müllerian-inhibiting substance (MIS) levels (P < 0.001), smaller ovarian dimensions (P < 0.05), lower testosterone levels (P = 0.035), lower free androgen index (P = 0.019), and enhanced bone metabolism (P = 0.003); although the prevalence of low BMD was higher in women with DOR who were younger than 41, this relationship was not of statistical significance (P = 0.106). Women younger than 41 years of age with DOR were significantly more likely to manifest disturbed sleep (P = 0.049) and acknowledge dissatisfaction with sexual intimacy (P = 0.004) compared with those with infertility and normal ovarian reserve. After adjustment for potential confounders, a diagnosis of DOR was significantly associated with low BMD, increased bone turnover, sexual dissatisfaction, and disturbed sleep.

Conclusions: Our data suggest that DOR unmasked in the context of infertility evaluation has adverse implications for a woman's well-being that extend well beyond the thus far appreciated reproductive concerns. A decline in ovarian hormones, specifically estrogen and testosterone, concomitant with DOR may be hypothesized as a mechanism that can explain the observed multisystem ramifications of DOR including increased bone turnover, low BMD, sexual distress, and disturbed sleep.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aging / physiology
  • Anti-Mullerian Hormone / blood
  • Bone Diseases, Metabolic / complications*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Female
  • Follicle Stimulating Hormone / blood
  • Humans
  • Infertility / physiopathology*
  • Mood Disorders / complications
  • Ovarian Follicle / physiopathology*
  • Premenopause / physiology*
  • Primary Ovarian Insufficiency / blood
  • Primary Ovarian Insufficiency / complications*
  • Prospective Studies
  • Quality of Life
  • Regression Analysis
  • Sexual Dysfunction, Physiological / complications
  • Sleep Initiation and Maintenance Disorders / complications
  • Testosterone / blood

Substances

  • Testosterone
  • Anti-Mullerian Hormone
  • Follicle Stimulating Hormone