Metabolic health and IVF outcome in infertile over 40: results from our clinical experience

With maternal age increasing every year, the number of women above 40 years of age candidate to fertility treatment has become significant. Half of them are diagnosed with infertility associated with diminished ovarian reserve, which is measured considering the antral follicular count (AFC) and antimüllerian hormone (AMH) levels. According to some studies, diminished ovarian reserve appears to be an early marker of cardiovascular risk. This observational retrospective study included 167 patients between 40 and 45 years of age who underwent ART procedures between 2020 and 2023, with the aim of exploring the possible associations between metabolic and inflammatory profile, ovarian reserve and ART outcomes. The results of the study confirm the importance of ovarian reserve markers on some ART outcomes, as AMH and AFC positively correlate with number of oocytes retrieved (r: 0.5; p<.0001for AMH; r: 0.6; p<.0001 for AFC) and number of embryos obtained (1 versus 2; z: -2.8; p<.005 for women with AMH<1.2 ng/dl and AFC<5 as compared to the remnant; 3 versus 2; z: -3.5; p=.0005 for women with AMH ≥3 ng/dl and AFC≥5 as compared to the remnant). Median AMH levels were significantly lower (p=.0001) in those infertile patients who did not obtain the pregnancy (1.3 ng/ml) in comparison with those who had miscarriage (3.1 ng/ml) or achieved an evolving pregnancy (3.2 ng/ml). On the other hand, metabolic and inflammatory markers did not show a correlation with either AMH or ART outcome, but women with suboptimal glucose levels (≥92 g/dl) tend to have lower AMH barely reaching significance (0.83 ng/ml, as compared to those with optimal values of glucose 1.38 ng/ml; z: -1.95; p=.0508). Moreover, in women with elevated triglycerides median AFC was significantly lower (5 AFC) as compared to those infertile women with optimal values of triglycerides (8 AFC) (z: -2.1; p=.03). As a result, it cannot be confirmed that poor responders to ART procedures have an adverse inflammatory-metabolic profile. While the small sample size examined acted as a limiting factor on our results, it is confirmed that somatic and ovarian aging are entangled in a complex manner, and future studies involving younger infertile women and women above 40 who achieved a spontaneous pregnancy are needed to share further light into this correlation.