Impact of the Etiology of Diminished Ovarian Reserve on Assisted Reproductive Technology Outcomes: A Multicenter Retrospective Cohort Study

AIM: To investigate whether the etiology of diminished ovarian reserve (DOR) independently influences outcomes of assisted reproductive technology (ART). METHODS: This multicenter, retrospective cohort study was a secondary analysis of a nationwide cohort established by the Reproductive Endocrinology Committee of the Japanese Society of Obstetrics and Gynecology. Women with DOR (anti-Müllerian hormone [AMH] levels < 1.1 ng/mL) who initiated their first in vitro fertilization and/or intracytoplasmic sperm injection cycle between January and December 2021 were included in the study. The causes of DOR were classified as idiopathic, previous anticancer treatment, ovarian surgery for endometriosis, or ovarian surgery for ovarian tumors other than endometriosis. Multivariate logistic regression analyses were performed to identify factors associated with ongoing pregnancy and live births. RESULTS: Overall, 606 women were included in this study. Baseline AMH levels differed among DOR etiologies and were the lowest in women with previous anticancer treatment. In multivariate analyses, age, number of oocytes retrieved, and number of good-quality embryos were independently associated with ongoing pregnancy and live birth, whereas the etiology of DOR was not. The cumulative ongoing pregnancy and live birth rates per embryo transfer cycle did not differ significantly among DOR etiologies. CONCLUSION: In this cohort, treatment outcomes were more strongly associated with age and embryo-related factors than with the underlying etiology of DOR. However, because the number of women with previous anticancer treatment was limited, further studies are needed to clarify the impact of chemotherapy-related DOR.