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Is High FSH Associated with Increased Miscarriages?
A recently published study offers optimistic news to young women with high FSH or diminished ovarian reserve who achieve pregnancy with IVF. High FSH is not associated with miscarriage in women under 35, and there is no indication that it is associated with higher levels of aneuploidy.
Researchers at Shady Grove Fertility Center participated in a retrospective cohort study analyzing 8,219 IVF cycles from 2009 to 2013. According to Dr. Kate Devine, it’s been an ongoing area of debate as to whether young patients in general with diminished ovarian reserve have worse outcomes than young patients with normal ovarian reserve, given that their egg quality is expected to be good in the vast majority of cases.
“We looked at pregnancies occurring in patients with elevated FSH relative to those occurring in women with normal FSH – whether they had any increased chance of miscarriage. And it turned out that in women who were older, they do in fact have a slightly increased chance of miscarriage, whereas women who were in the younger cohort don’t,” says Dr. Devine, a reproductive endocrinologist and co-director of research at Shady Grove Fertility. Researchers started to see a statistical increase in women over the age of 35.
The data directly serves to reassure young women with low ovarian reserve that once they are pregnant, by and large they should expect good outcomes, Devine says, and she uses this information when counseling patients.
The data also strongly support that while young women with diminished ovarian reserve have fewer eggs, there seems to be no correlation with egg quality. “When we looked at rates of aneuploidy among pregnancy losses, we didn’t see a statistically significant difference in abnormal karyotype across all age groups with diminished ovarian reserve,” she explains.
“A lot of us believe that in young women [IVF patients] with diminished ovarian reserve for age ,it’s generally reasonable to try with their own eggs,” Devine says. “Young patients, even with low ovarian reserve should not be shuttled directly to donor egg, in my opinion.”