The Role of Folliculo-Luteal Function in the Emergence of Age-Related Reproductive Disorders
Increasing age in women, especially being over 35 years of age, is accompanied by gradually worsening fertility as well as expectable pregnancy outcome. Nonetheless, in our patient population, this trend vanished with the normalisation of folliculo-luteal function (FLF).
In unexplained infertility (UI), 13.6 % (N = 147) of patients in the untreated control group conceived within 1 year after 4.4 years of average infertility, while 98.5 % (N = 621) of patients with physiological FLF conceived (average luteal progesterone >23 ng/ml). We failed to demonstrate any significant differences between patients <35 years and ≥35 years of age with physiological FLF, either regarding monthly pregnancy rate (26.7 % and 26.5 % on average), yearly cumulative pregnancy rate (98.5 and 98.4 %) or time to pregnancy (3.14 ± 2.4 and 3.22 ± 2.3 cycles).
In UI, the prevalence of preterm birth, IUGR, newborn weight under 2,500 and 1,500 g, miscarriage and preeclampsia was 30.2 %, 30.2 %, 35.8 %, 11.3 %, 42.0 % and 5,6 %, respectively, in the untreated group, whereas with physiological FLF, it was 0.7 %, 0.7 %, 1.0 %, 0.18 %, 3.2 % and 0 %, respectively. No significant differences were found, respectively, in case of physiological FLF in the pregnancy outcomes of women <35 years and ≥35 years: preterm birth 0.7 and 0.8 %, IUGR 0.7 and 0.8 %, newborns under the weight of 2,500 g 2.3 and 1.5 % and newborns under the weight of 1,500 g 0.2 and 0 %.
The general opinion is that the organic ageing of the reproductive system and particularly the oocyte that is proportional to the patient’s age primarily causes age-related deterioration of reproductive capability. Notwithstanding, our results imply that their primary cause is FLF insufficiency of different levels, which occurs more often in parallel with age and seems to be reversible by FLF normalisation. The limit of FLF normalisation is when spontaneous ovulatory cycles cease, usually around 45 years of age (generally 5 years before the menopause).
KeywordsPreterm Birth Pregnancy Outcome Adverse Pregnancy Outcome Recurrent Miscarriage Untreated Control Group
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