Background
Methods
Subjects
Inclusion criteria
Exclusion criteria
Pelvic ultrasonography
Evaluation of endocrine dimensions
Statistical analysis
Results
Demographic and socioeconomic characteristics
Parameters | Infertile Patient Age groups (years) | Control Age groups (years) | Infertile vs. controls p- value | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
25–28 | 29–35 | 36–39 | p- value | Total | 25–28 | 29–35 | 36–39 | p- value | Total | ||
Number of women [n (%)] | 90 (21.2) | 210 (49.6) | 123 (29.07) | – | 423 (100) | 101 (26.01) | 165 (42.5) | 122 (31.4) | – | 388 (100) | – |
Age (years) [mean ± SD] | 26.8 ± 1.1 | 32.6 ± 1.7 | 37.9 ± 1.4 | _ | 29.9 ± 4.10 | 26.94 ± 1.8 | 33.13 ± 1.9 | 38.15 ± 1.7 | 30.41 ± 3.9 | 0.6a | |
BMI [median (95% population limit)] | 26.4 (17.4;26.9) | 27 (19.1;27.8) | 27.6 (20.1;36.9) | 0.08b | 25.3 (18.1;29.9) | 26.3 (19.1;29.5) | 26.9 (18.9;31.1) | 28.1 (18.4;31.9) | 0.03b | 24.9 (18.2;30.1) | 0.8b |
Previously conceived [n (%)] | 32 (35.5) | 98 (46.6) | 68 (55.2) | 0.71b | 198 (46.8) | 84 (83.1) | 112 (67.8) | 98 (80.3) | 0.001 | 294 (75.7) | < 0.001 |
Any history of Anemia [n (%)] | |||||||||||
Present | 69 (76.6) | 112 (53.3) | 48 (39) | 0.002c | 229 (54.1) | 29 (28.7) | 55 (33.3) | 78 (63.9) | < 0.001c | 162 (41.7) | < 0.001c |
Absent | 21 (23.3) | 98 (46.6) | 75 (609) | 194 (45.8) | 72 (71.2) | 110 (66.6) | 44 (36.06) | 226 (58.2) | |||
Physical Activity [n (%)] | |||||||||||
Low (< 2 h/week) | 43 (47.7) | 112 (53.3) | 69 (56) | < 0.001c | 224 (52.9) | 23 (22.7) | 36 (21.8) | 23 (18.8) | < 0.001c | 82 (21.1) | < 0.001c |
Moderate (2–6 h/week) | 25 (27.7) | 78 (37.1) | 25 (20.3) | 128 (30.2) | 33 (32.6) | 78 (47.2) | 43 (35.2) | 154 (36.9) | |||
Intense (> 6 h/week) | 22 (24.4) | 20 (9.5) | 29 (23.5) | 71 (16.7) | 45 (44.5) | 51 (30.9) | 56 (45.9) | 152 (39.1) | |||
Caffeine consumption (mg/day) [n (%)] | |||||||||||
Non- consumers | 40 (44.4) | 98 (46.6) | 66 (53.6) | < 0.001c | 204 (48.2) | 61 (60.3) | 75 (45.4) | 48 (39.3) | < 0.002c | 184 (47.4) | 0.3c |
Moderate consumers (100–300) | 30 (33.3) | 76 (36.1) | 41 (33.3) | 147 (34.7) | 21 (20.7) | 51 (30.9) | 31 (25.4) | 103 (26.5) | |||
Intense consumers (> 300) | 20 (22.2) | 36 (17.1) | 16 (13) | 72 (17) | 19 (18.8) | 39 (23.6) | 43 (35.2) | 101 (26) | |||
Occupation [n (%)] | |||||||||||
House wife | 15 (16.6) | 85 (40.4) | 39 (31.7) | 0.5c | 139 (32.8) | 43 (42.5) | 76 (46) | 47 (38.5) | 0.6c | 166 (42.7) | 0.5c |
Business women | 25 (27.7) | 45 (21.4) | 13 (10.5) | 83 (19.6) | 5 (4.9) | 12 (7.2) | 9 (7.3) | 26 (6.7) | |||
Govt. employees | 15 (16.6) | 10 (4.7) | 8 (6.5) | 33 (7.8) | 3 (2.9) | 9 (5.4) | 6 (4.9) | 18 (4.6) | |||
Others | 35 (38.8) | 70 (33.3) | 63 (51.2) | 168 (39.7) | 50 (49.5) | 68 (41.2) | 58 (47.5) | 176 (45.3) | |||
Monthly Income (Rupees) [n (%)] | |||||||||||
Low income 30,000-50,000 | 5 (5.5) | 10 (4.7) | 16 (13) | < 0.001c | 31 (7.3) | 28 (27.7) | 35 (21.1) | 31 (25.4) | < 0.001c | 94 (24.2) | 0.1c |
Moderate income 50,000- 100,000 | 25 (27.7) | 38 (18) | 21 (17) | 84 (19.8) | 39 (38.6) | 59 (35.7) | 45 (36.8) | 143 (36.8) | |||
High income > 100,000 | 60 (66.6) | 162 (77.1) | 86 (69.9) | 308 (72.8) | 34 (33.6) | 71 (43) | 46 (37.7) | 151 (38.9) |
Reproductive and menstrual characteristics
Parameters | Infertile Patient Age groups (years) | Control Age groups (years) | Infertile vs. controls p-value | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
25–28 | 29–35 | 36–39 | p- value | Total | 25–28 | 29–35 | 36–39 | p- value | Total | ||
Number of women [n (%)] | 90 (21.2) | 210 (49.6) | 123 (29.07) | – | 423 (100) | 101 (26.01) | 165 (42.5) | 122 (31.4) | – | 388 (100) | – |
Age at menarche (years) n (%)] | |||||||||||
≤ 11 | 12 (3.3) | 35 (16.6) | 24 (19.5) | 0.1c | 71 (16.7) | 8 (7.9) | 11 (6.6) | 14 (11.4) | 0.2c | 33 (8.5) | 0.09c |
12–13 | 49 (54.4) | 108 (51.4) | 59 (47.9) | 216 (51) | 79 (78.2) | 98 (59.3) | 23 (18.8) | 200 (51.5) | |||
13–14 | 10 (11.1) | 45 (25.7) | 31 (14.7) | 86 (20.3) | 12 (11.8) | 41 (24.8) | 81 (66.3) | 134 (34.5) | |||
≥ 15 | 19 (21.1) | 22 (10.4) | 9 (7.3) | 50 (11.8) | 2 (1.9) | 15 (9) | 4 (3.2) | 21 (5.4) | |||
Menstrual Cycle length (days) [mean ± SD] | 33.4 ± 3.1 | 29.9 ± 1.9 | 28.8 ± 1.8 | 0.4a | 30.2 ± 2.0 | 28.9 ± 2.1 | 29.1 ± 2.3 | 30.2 ± 1.9 | 0.3a | 29.9 ± 2.1 | 0.5a |
Frequency of Menses (days) [n (%)] | |||||||||||
Frequent (< 21) | 31 (34.4) | 85 (40.4) | 35 (28.4) | < 0.001c | 151 (35.6) | 1 (0.99) | 0 (0.00) | 1 (0.08) | < 0.001c | 2 (0.51) | 0.01c |
Normal (24–38) | 14 (15.5) | 46 (21.9 | 29 (23.5) | 89 (21) | 100 (99.0) | 164 (99.3) | 121 (99.1) | 385 (99.2) | |||
Infrequent (> 38) | 45 (50) | 79 (37.6) | 59 (47.9) | 183 (43.2) | 0 (0) | 1 (0.6) | 0 (0) | 1 (0.25) | |||
Cycle to Cycle variation over 12 months (days) [n (%)] | |||||||||||
Regular (variation ±2–20 days) | 15 (16.6) | 29 (13.8) | 14 (11.3) | < 0.002c | 58 (13.7) | 101 (100) | 165 (100) | 121 (99.1) | < 0.001c | 387 (99.8) | 0.03c |
Irregular (variations > 20 days) | 75 (83.3) | 190 (90.4) | 109 (88.6) | 374 (88.4) | 0 (0) | 0 (0) | 1 (0) | 1 (0.25) | |||
Duration of blood flow (days) [n (%)]in one episode | |||||||||||
Prolonged (> 8) | 23 (25.5) | 65 (30.9) | 31 (25.2) | < 0.001c | 119 (28.1) | 19 (18.8) | 35 (21.2) | 15 (12.2) | < 0.001c | 69 (17.7) | 0.2c |
Normal (4–8) | 12 (3.3) | 35 (16.6) | 19 (15.4) | 66 (15.6) | 53 (79.2) | 80 (48.4) | 62 (50.8) | 195 (50.2) | |||
Shortened (< 4) | 55 (61.1) | 110 (52.3) | 73 (59.3) | 238 (56.2) | 29 (28.7) | 50 (30.3) | 45 (36.8) | 123 (31.7) | |||
Monthly blood loss (ml) [n (%)] | |||||||||||
Light (< 5) | 23 (25.5) | 73 (34.7) | 15 (12.1) | < 0.001c | 111 (26.2) | 18 (17.8) | 22 (13.3) | 60 (49.1) | < 0.001c | 100 (25.7) | 0.3c |
Normal (5–80) | 25 (27.7) | 49 (23.3) | 10 (8.1) | 84 (19.8) | 55 (54.4) | 101 (61.2) | 52 (42.6) | 208 (53.6) | |||
Heavy (> 80) | 20 (22.2) | 63 (30) | 36 (29.2) | 119 (28.1) | 25 (24.7) | 40 (24.2) | 10 (8.1) | 137 (35.3) | |||
No bleeding | 22 (24.4) | 25 (11.9) | 38 (30.8) | 85 (20) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |||
Occurrence of Blood clots [n (%)] | |||||||||||
Yes | 26 (28.8) | 98 (46.6) | 48 (39) | < 0.001c | 172 (40.6) | 59 (5.8) | 129 (78.1) | 66 (54) | < 0.001c | 254 (65.4) | 0.07c |
No | 64 (71.1) | 112 (53.3) | 75 (60.9) | 251 (59.3) | 31 (30.6) | 36 (21.8) | 56 (45.9) | 123 (31.7) | |||
Former history of abortions [n (%)] | |||||||||||
0 | 81 (90) | 191 (90.9) | 118 (95.9) | < 0.001c | 390 (92.1) | 97 (96) | 158 (95.7) | 110 (90.1) | < 0.001c | 365 (94) | 0.2c |
≥ 1 | 9 (10) | 19 (9) | 5 (4.06) | 33 (7.8) | 4 (3.9) | 7 (4.2) | 12 (9.8) | 23 (5.9) |
Evaluation of ovarian reserve based on ultrasound findings and hormonal parameters in age-specific subgroups of patients and controls
Parameters | Infertile Patient Age Group (years) | Control Age Group (years) | Infertile versus control p-value | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
25–28 | 29–35 | 36–39 | p-value | Total | 25–28 | 29–35 | 36–39 | p-value | Total | ||
Number of women [n (%)] | 90 (21.3) | 210 (49.6) | 123 (29.07) | 423 (100) | 101 (26.0) | 165 (42.5) | 122 (31.4) | 388 (100) | |||
Endocrine parameters | |||||||||||
AMH (ng/ml) [median (95% population limit)] | 5.1 (3.2;9.9) | 4.8 (4.5;8.0) | 3.4 (2.5;7.1) | < 0.002b | 4.8 (4.5;6.9) | 5.4 (4.9;9.6) | 5.0 (4.9;9.4) | 3.6 (3.6;9.2) | < 0.001b | 5.0 (3.2;6.8) | 0.08b |
AMH (ng/ml) categories [n (%)] | |||||||||||
< 0.7 | 3 (3.3) | 28 (13.3) | 25 (20.3) | 0.002c | 56 (13.2) | 4 (3.96) | 12 (7.3) | 18 (14.7) | < 0.001c | 34 (8.7) | 0.3c |
0.7–4.5 | 16 (17.7) | 45 (21.4) | 65 (52.8) | 126 (29.7) | 15 (14.9) | 38 (23.0) | 52 (42.6) | 105 (27.0) | |||
4.5–7.9 | 45 (50) | 107 (50.9) | 18 (14.6) | 170 (40.1) | 68 (67.3) | 85 (51.5) | 47 (38.5) | 200 (51.5) | |||
≥ 8.0 | 26 (28.9) | 30 (14.3) | 15 (12.2) | 71 (16.7) | 14 (13.9) | 30 (18.1) | 5 (4.0) | 49 (12.6) | |||
FSH (IU/L) [median (95% population limit)] | 6.9 (6.5;8.1) | 7.1 (7.1;8.3) | 7.2 (8.1;9.5) | 0.3b | 7.1 (7.6;8.4) | 6.5 (5.5;6.8) | 6.7 (5.9;7.2) | 6.8 (5.8;7.0) | 0.8b | 6.6 (6.0;7.1) | 0.01b |
FSH (IU/L) categories [n (%)] | |||||||||||
< 4 | 17 (18.8) | 22 (10.5) | 3 (2.4) | 0.4c | 42 (9.92) | 5 (4.9) | 11 (6.6) | 4 (3.3) | 0.5c | 20 (5.1) | 0.07c |
5–8 | 58 (64.4) | 158 (75.2) | 65 (52.8) | 281 (66.4) | 45 (44.5) | 75 (45.5) | 41 (36.0) | 161 (41.5) | |||
9–14 | 10 (11.1) | 9 (4.3) | 35 (28.5) | 54 (12.7) | 35 (34.6) | 45 (27.2) | 69 (56.5) | 149 (38.4) | |||
15–20 | 5 (5.5) | 21 (10) | 20 (16.3) | 46 (10.8) | 16 (15.8) | 34 (26.6) | 8 (6.5) | 58 (14.9) | |||
LH (IU/L) [median (95% population limit)] | 6.4 (6.0;7.1) | 6.3 (5.8;6.7) | 6.5 (6.1;7.0) | 0.7b | 6.3 (6.1;6.8) | 5.9 (5.5;6.3) | 5.5 (4.4;5.9) | 5.4 (5.1;6.7) | 0.07b | 5.5 (5.1;7.1) | 0.03b |
LH/FSH-ratio (IU/L) [median (95% population limit)] | 1 (0.8;1.8) | 0.9 (0.6;1.7) | 0.9 (0.8;1.5) | 0.4b | 0.9 (0.7;1.6) | 0.8 (0.5;1.9) | 0.8 (0.4;1.5) | 0.8 (0.6;1.8) | 0.7b | 0.8 (0.5;1.7) | 0.01b |
Ultrasonography parameters | |||||||||||
Total number of AFC [median (95% population limit)] | 30 (26.9;31.5) | 22 (21.7;24.6) | 14 (12;14.2) | < 0.0001b | 21 (20.5;28.6) | 29.0 (24.7;29.0) | 23.0 (24.7;29.0) | 14.0 (16.4;20.5) | < 0.001b | 0.7b | |
AFC categories [n (%)] | |||||||||||
< 8 | 0 (0) | 14 (6.7) | 25 (20.3) | < 0.0001c | 39 (9.2) | 0 (0) | 2 (1.2) | 8 (6.5) | 0.0001c | 10 (2.5) | 0.7c |
9–20 | 15 (16.7) | 71 (3.3) | 88 (71.5) | 174 (41.1) | 28 (27.7) | 66 (40) | 70 (57.3) | 164 (42.2) | |||
21–45 | 69 (76.7) | 117 (55.7) | 8 (6.5) | 194 (45.8) | 68 (67.3) | 93 (56.3) | 43 (35.2) | 204 (52.5) | |||
> 46 | 6 (6.7) | 8 (3.8) | 2 (1.6) | 16 (3.78) | 5 (4.9) | 4 (2.4) | 1 (0.8) | 10 (2.5) | |||
Ovarian volume (ml) [median (95% population limit)] | 5.6 (3.2;11.6) | 5.4 (2.5;10.6) | 5.3 (2.3;11.9) | 0.2b | 5.5 (2.5;11.7) | 5.1 (2.1; 8.97) | 4.9 (2.7;9.1) | 4.5 (2.3;9.9) | 0.001b | 4.9 (2.3;8.9) | 0.008b |
Age Groups | Infertile patient Age groups | Control Age groups | Mean difference (95% Cl) | Infertile versus control p-value | ||||
---|---|---|---|---|---|---|---|---|
25–28 | 29–35 | 36–39 | 25–28 | 29–35 | 36–39 | |||
No of samples n (%) | 90 (21.2) | 210 (49.6) | 123 (29.07) | 101 (26.03) | 165 (42.5) | 122 (31.4) | ||
Total AFC [median (95% population limits)] | 27.1 (23.9;30.1) | 23.0 (22.3;25.2) | 17.1 (15.3;19.9) | 28.9 (24.8;31.2) | 23.4 (19.7;25.6) | 16.9 (14.9;19.8) | −0.29 (−2.01;1.33) | 0.6 |
AFC (mm), mean proportion (95% population limits) | ||||||||
AFC 2–5 | 0.71 (0.7;0.72) | 0.68 (0.61;0.76) | 0.61 (0.59;0.72) | 0.8 (0.71;0.79) | 0.76 (0.61;0.72) | 0.68 (0.64;0.69) | −0.06 (− 0.09; −0.03) | < 0.001 |
AFC 5–8 | 0.41 (0.37;0.36) | 0.42 (0.38;0.44) | 0.44 (0.39;0.41) | 0.31 (0.28;0.32) | 0.3 (0.29;0.32) | 0.3 (0.26;0.32) | 0.03 (−0.005;0.054) | 0.2 |
AFC 8–10 | 0.06 (0.03;0.08) | 0.07 (0.05;0.08) | 0.08 (0.07;0.98) | 0.04 (0.03;0.04) | 0.04 (0.03;0.05) | 0.05 (0.05;0.07) | 0.04 (0.03;0.05) | < 0.001 |
Prevalence of poor ovarian reserves
Ovarian reserve markers and infertility investigation
Parameters | Age groups | |||
---|---|---|---|---|
25–28 | 29–35 | 36–39 | Total | |
No of samples [n (%)] | 90 (21.2) | 210 (49.6) | 123 (29.07) | 423 (100) |
Infertility duration (months) [median (95% population limits)] | 28 (15;42) | 31 (10;60) | 35 (15;61) | 29 (11;58) |
Primary infertility [n (%)] | 78 (86.6) | 85 (40.4) | 57 (46.3) | 220 (52.0) |
Secondary infertility [n (%)] | 12 (13.3) | 125 (59.5) | 166 (134.9) | 303 (71.6) |
History of fertility treatment [n (%)] | 20 (22.2) | 198 (94.3) | 110 (89.4) | 328 (77.5) |
Female factors [n (%)] | ||||
Anovulation | 2 (2.2) | 3 (1.4) | 1 (0.8) | 6 (1.4) |
Endometriosis | 3 (3.3) | 5 (2.5) | 4 (3.3) | 12 (2.8) |
Tubal Blockage | 6 (6.6) | 8 (3.8) | 4 (3.2) | 18 (4.2) |
Multiple female factor | 12 (13.3) | 20 (9.5) | 8 (6.5) | 40 (9.5) |
Sub-mucous myomas | 8 (8.8) | 28 (13.3) | 7 (5.7) | 43 (10.2) |
Laparotomy | 3 (3.3) | 5 (2.4) | 1 (0.8) | 9 (2.1) |
Male factor [n (%)] | ||||
Male infertility | 32 (35.5) | 75 (35.7) | 48 (39.02) | 155 (36.6) |
Both Male and Female factor | 7 (7.7) | 49 (23.3) | 36 (29.2) | 92 (21.7) |
Unexplained infertility factors | 17 (18.8) | 15 (7.1) | 14 (11.3) | 46 (10.8) |