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Menstrual Cycle Length could be a Marker for Ovarian Reserve in Patients Undergoing IVF
November 18, 2008
A recent study published online in the journal Fertility and Sterility identifies the correlation between mean length of the menstrual cycle and success rate of in vitro fertilization (IVF), suggesting its use as age-independent marker of ovarian reserve.

Thomas Brodin, from the Department of Obstetrics and Gynecology, Eskilstuna, Sweden, and colleagues conducted the prospective observational study by analyzing 6271 IVF/ICSI treatment cycles. Researchers also recorded self-reported mean number of menstrual days of study subjects for the previous year before the initiation of IVF/ICSI treatment. The study results showed an inverse association between mean menstrual cycle length and increasing age of study subjects. The odds of delivery in women with menstrual cycle length >34 days was found to be higher by almost two-fold when compared to menstrual cycle length of <26 days after the treatment. The results therefore suggest a linear correlation between menstrual cycle length, and pregnancy and delivery rates, even after adjusting for age. A crucial association of menstrual cycle length with embryo quality, and ovarian response to follicle stimulating hormone (FSH)/human menopausal gonadotropin (hMG) stimulation was also established through the study.

In an earlier prospective study, Chanley M Small, et al. (Epidemiology, 2006) investigated the association of menstrual cycle length or bleeding length, with fertility or spontaneous abortion. During the study, information regarding menstrual bleeding, use of birth control, intercourse, and covariates was collected from daily diaries maintained by 470 study subjects. To identify early pregnancies, urine samples collected during menstrual cycles were assayed for human chorionic gonadotropin (hCG), and participants were followed-up for a period of one year or until the end of a clinical pregnancy. Study results demonstrated that highest fecundity was linked to menstrual cycle lengths of 30 to 31 days (fecundity ratio [FR]= 0.6), with reduced conception rates in patients with shorter cycles and greater chances of spontaneous abortion in shorter or longer menstrual cycles. The researchers also observed that fecundity rate was highest in cycles with 5 days of menstrual bleeding, and lower in cycles with up to 4 days of bleeding (for bleed lengths of 4 days, FR=0.5, and for bleed lengths less than 4 days, FR=0.6). The chances of spontaneous abortion were lower, after bleed length greater than 5 days, in contrast to 5-day bleeds.

Contrary to the recent findings, in a recent retrospective study, Matalliotakis I, et al., (Journal of Obstetrics and Gynecology, 2008) found no significant association between IVF outcome and various epidemiological factors such as menstrual cycle length, age at menarche, duration of menstrual flow, lifestyle, and family history. Researchers evaluated medical files of 297 infertile women (151 women who conceived after IVF-ET and 146 controls who underwent 288 IVF-ET cycles without conceiving) who had undergone laparoscopy and subsequent IVF-ET treatment during 1996 and 2002. The study results also confirmed an inverse relation between women’s age and IVF success.

In recent days, numerous ovarian reserve tests (ORTs) are being performed as a part of the routine diagnostic procedures for infertile patients opting for assisted reproductive techniques (ART). The key goal of such tests is to predict a patient’s response to ovarian stimulation and their chances of becoming pregnant through such procedures. Early follicular-phase blood values of FSH, estradiol, inhibin B and anti-Müllerian hormone (AMH), antral follicle count (AFC), ovarian volume (OVVOL) and the ovarian blood flow are some of the currently used measures for predicting ovarian response and chances of pregnancy. The current study suggests that a precise menstrual cycle history could also be an effective prognostic marker in patients undergoing IVF/intracytoplasmic sperm injection (ICSI) procedures. However, further clinical trials are crucial before adopting menstrual cycle length as an accurate measure of the quantitative ovarian reserve.