Follicular density in ovarian biopsy of infertile women: a novel method to assess ovarian reserve |
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Authors: | Lass A; Silye R; Abrams DC; Krausz T; Hovatta O; Margara R; Winston RM |
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Institution: | Department of Obstetrics and Gynaecology, Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK. |
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Abstract: | The ageing ovary appears to be characterized by depletion of primordial
follicles. The relationship between infertility and the number of follicles
in the ovarian cortex is not known. Moreover, there are no accurate markers
or clinical methods to predict the decline in ovarian reserve. This study
investigates the correlation between early follicular follicle stimulating
hormone, ovarian size and follicular density in 60 infertile women aged
19-45 years (mean = 34.4 +/- 5.5). An ovarian biopsy was taken from each
patient while performing diagnostic laparoscopy (n = 28) or laparotomy for
tubal surgery or myomectomy (n = 32). The median number of follicles was
similar in tubal and unexplained infertility patients (9.5 versus 5.5).
Increasing age showed a significant negative correlation with follicular
density and ovarian volume (r = -0.46, P = 0.0003;. r = -0.43, P = 0.0016,
respectively). In women > or = 35 years of age the ovarian volume showed
a strong correlation with follicular density (r = 0.71, P < 0.0001). Our
results indicate that infertile women in their late thirties and over have
a decreased ovarian reserve which could possibly be predicted by ovarian
volume measurement. Ovarian biopsy may have a place as part of infertility
evaluation in older women.
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