Narrow Results

It has been generally accepted that Hwangryunjihwang-tang (H-tang) is a useful prescription for treating polydipsia and to prevent obesity induced by a high-fat diet. The aim of this study was to clarify whether H-tang improved reproductive dysfunction caused by obesity in mice. Mice were fed a high density protein and lipid diet for 4 weeks, followed by administration of H-tang at 480 mg/kg body weight per day for 4 days. Thereafter, changes of body weight, ovulation rate, in vitro and in vivo fertilization, embryonic development and implantation rate were measured. H-tang markedly reduced the body weight of obese mice fed a high-fat diet, but not mice fed a normal diet. H-tang significantly improved ovulation rates, in vitro and in vivo fertilization rates and embryonic development. These results indicate pharmacological reversal of reproductive dysfunction caused by obesity, perhaps by adjusting internal secretions and metabolic functions.

Polycystic ovary syndrome (PCOS) is a complex heterogeneous disorder characterized by androgen excess and ovulatory dysfunction; it is now known to be closely linked to metabolic syndrome. Recent research suggests that insulin resistance plays an important role in the pathogenesis of PCOS which may lead to the excessive production of androgens by ovarian theca cells. Currently there is no single drug that can treat both the reproductive and metabolic complications of the disorder. Existing pharmaceutical agents such as hormonal therapies have been associated with side effects and are not appropriate for PCOS women with infertility. Additionally, insulin sensitizing agents useful for treating the metabolic abnormalities in PCOS have limited efficacy for treating reproductive aspects of the disorder. Chinese herbal medicines have a long history of treating gynaecological problems and infertility and therefore may be a novel approach to the treatment of PCOS. Current research demonstrates that the compounds isolated from herbs have shown beneficial effects for PCOS and when combined in an herbal formula can target both reproductive and metabolic defects simultaneously. Therefore, further investigation into Chinese herbal medicine in the treatment of PCOS is warranted.

Acupuncture and the Treatment of Infertility.

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In vitro maturation (IVM) is an assisted reproductive technology (ART) whereby immature cumulus-oocyte complexes are collected and matured in vitro, without need for controlled ovarian stimulation and ovulation triggering. Advantages of IVM over in vitro fertilization (IVF) include mild or no stimulation, lower medication costs and less patient burden. However, early clinical outcomes with IVM were suboptimal. More recently, clinical studies reported live birth rates after IVM of about 40%. New IVM culture systems are being used to improve the efficacy of IVM. These have been in widespread use for animals for many years and are now showing promise in the clinical setting. Patients more likely to benefit from IVM over IVF include those at risk of OHSS (e.g. women with polycystic ovary syndrome), when the time for ovarian stimulation is limited, or where sustained elevations of estradiol are contraindicated (e.g. oncofertility indications). The main barrier to use of IVM to date was its relative efficacy compared with IVF, and there have also been concerns over the health of infants born following IVM. However, no differences in congenital abnormalities between IVM and other ARTs have been identified. In addition, there is a lack of both experience and standardized protocols. Strategies to overcome barriers to the use of IVM include better training for clinicians, more and better funded research in the field, and improved recognition of IVM by fertility specialists. Overall, IVM offers a valuable alternative for ART in select patient populations. New approaches to IVM appear to have the potential to achieve pregnancy outcomes equivalent to those after IVF. Increasing the use of IVM in the future can be achieved with improved training and education for fertility specialists, and increased funding for IVM research, with the ultimate goal of improving fertility outcomes.

Vitamin D is a lipid soluble vitamin synthesized by the skin upon exposure to UV light. Approximately 10–20% of vitamin D comes from dietary sources and 25OH-D is its circulating form. Vitamin D receptors are found in reproductive tissues including ovary, uterus, and endometrium permitting investigators to hypothesize a role for vitamin D in reproduction. Indeed, a number of animal studies provide evidence of vitamin D’s importance in fertility. Studies in humans, however, generally have not supported an effect of vitamin D on fertility outcomes. Several retrospective cohort studies did not demonstrate an association between vitamin D levels and pregnancy. Similarly, one study did not find correlation between anovulatory infertility and vitamin D intake. Very low levels of vitamin D, however, were associated with miscarriage in another study. A large meta-analysis of 11 studies and 2700 women did show an improvement in IVF success rates in those with higher levels of vitamin D. Finally, two small studies on vitamin D supplementation and pregnancy did not show a benefit of increasing vitamin D intake. In conclusion, the literature at best shows a minimal impact of vitamin D on infertility and IVF outcomes.

Objectives: The frequency of, and relationship between, the various manifestations of male sexual dysfunction in infertile couples have been poorly investigated, especially in Vietnam. Our study aims to assess the prevalence of premature ejaculation and erectile dysfunction in infertile couples using validated instruments, and the relationship between these disorders.

Method: Cross-sectional descriptive study, using validated questionnaires including the Premature Ejaculation Diagnostic Tool (PEDT) and the International Index of Erectile Function-15 (IIEF-15), to measure the incidence of these problems in 255 male partners of infertile couples who were examined from January through December 2017, at the Center for Reproductive Endocrinology & Infertility, Hue University Hospital.

Results: The prevalence of overt premature ejaculation was 4.7%, probable premature ejaculation was 7.1%, and erectile dysfunction was 26.3% (mild: 19.3%, mild-to-moderate: 3.9%, moderate: 2.7%, and severe: 0.4%). The PEDT total score was negatively correlated to IIEF-15-EFD and IIEF-15 total scores (r $=-$0.322 and r $=-$0.348, respectively).

Conclusions:In light of the identified prevalence of premature ejaculation and erectile dysfunction in the studied population, screening for these conditions should be included in the evaluation of infertile couples. These two disorders could negatively reciprocal effect on each other.

Background: The delayed childbearing has doubled in prevalence during the last decade. It affects reproductive health, population distribution and economy. We use the public health approach to survey among women aged at least 35 years seeking fertility treatment.

Methods: A self-administered questionnaire-based survey was conducted in women aged at least 35 years attending an infertility clinic in a university hospital. The questionnaire consisted of background information and three domains: (1) reasons for delayed childbearing, (2) required social policy incentives, and (3) acceptability toward infertility treatment. Each domain was scored from ‘5 — most important’ to ‘1 — least important’.

Results: A total of 590 women (median age 38.0 years) were recruited; 86.4% of them held at least a bachelor degree and 93.2% had higher income than Thailand’s GDP per capita. They thought that the most appropriate age to have the first child was 28.7 years. The top three reasons for delayed childbearing were “I need more financial security”, “no spouse”, and “I need progress on my career”. The participants thought that “paid paternity leave”, “increase paid maternity leave”, and “good quality childcare” were essential for them to make an earlier fertility decision. The most acceptable infertility treatments were IUI, IVF/ICSI, and social oocyte banking.

Conclusions: Women who delayed childbearing focus on financial and career security or finding the proper partner before fertility decision making. However, they have greater concerns over family welfare than money when it comes to domestic issues. The social policy and the related fertility treatment should adapt to serve the needs of the people and promote national fertility rate.

Background: Polycystic ovarian syndrome (PCOS) is a common cause of infertility in women. In-vitro fertilization (IVF) is required in 20–30% of women with PCOS trying to conceive. This is associated with increased risk of multiple gestation and ovarian hyperstimulation syndrome. Improvements in IVF techniques, safety standards, and the increased use of frozen embryos in recent years have lead to improved outcomes for women with PCOS. We performed a systematic review and meta-analysis to compare these outcomes with women without PCOS.

Search Methods: A search of PubMed, EMBASE, the Cochrane Central Register of clinical trials, and Scopus databases for all articles published until November 16th, 2017 identified 21 studies comparing IVF outcomes in PCOS and non-PCOS women. Inclusion criteria were Rotterdam criteria PCOS, comparable IVF regimes, immediate IVF outcomes, and pregnancy outcomes. Studies were excluded if the control group included any PCOS criteria, donor oocytes, or in-vitro maturation.

Outcomes: No difference was observed in live birth rate per cycle in women with vs. without PCOS (RR $=$ 1.01 [0.89, 1.16]; ${\text{I}}^{\mathrm{\text{2}}}=$ 82%), but the live birth rate per first cycle in PCOS cycles (RR $=$ 0.93 [0.88, 0.99]) was slightly lower. There was also no difference in the clinical pregnancy rate (RR 1.02 [0.89, 1.17]) or biochemical pregnancy rate (RR 1.03 [0.99, 1.08]) observed between the two groups. PCOS was associated with a significantly higher number of oocytes retrieved (mean difference $=$ 3.6; 95% CI [2.8, 4.4]), risk of miscarriage (RR 2.90 [2.09, 4.02]), and risk of ovarian hyperstimulation syndrome (RR 3.42 [2.28, 5.13]) per cycle.

Conclusion: Despite a widespread perception of poor reproductive potential, women with PCOS experience IVF outcomes similar to those without PCOS. Although there is a slightly lower live birth rate during their first stimulation cycle, success rates are similar after multiple cycles. PCOS is associated with a higher risk of ovarian hyperstimulation syndrome. Further studies are required to mitigate this risk.

Objective: To determine the relationship between a Chlamydia trachomatis PCR positive diagnosis from cervical canal swabs and the presence of tubal diseases among infertile women in Vietnam.

Methods: In this cross-sectional descriptive study, women who sought infertility treatment at the Center for Reproductive Endocrinology & Infertility, Hue University Hospital, Vietnam, from June 2016 to June 2017 were enrolled. All study participants were interviewed, and PCR tests were then performed to diagnose Chlamydia from cervical canal swabs. Hysterosalpingogram (HSG) was carried out to examine the uterine cavity and fallopian tubes.

Results: Among 568 women whose mean age was 32.0 ± 5.1 years, the prevalence of C. trachomatis infection as detected by PCR was 5.8%. Eighty-one percent (460/568) of infertile women had normal HSG results, and abnormal HSG results were more frequent in women over 35 years old, in women with secondary infertility, and in those with a history of miscarriage or genital tract infection. However, there was no relationship between C. trachomatis PCR positivity and HSG results in infertile women.

Conclusions: The diagnosis of C. trachomatis infection using the cervical swabs is the useful but not an effective method for routine practice for predicting tubal obstruction in infertile women.

Background: Tubal evaluation is an integral part of the evaluation of female infertility. Hysterosalpingography (HSG) is the radiographic evaluation of the uterus and fallopian tubes, which has been used as a first-line test for tubal assessment since 1920s. Laparoscopy is considered to be the gold standard for the diagnosis and management of tubo-peritoneal pathology. The objective of this study is to evaluate and compare the diagnostic value of both HSG and laparoscopy for assessment of tubal occlusion.

Methods: This is a prospective cross-sectional study. Laparoscopic chromopertubation was conducted on 125 consecutive infertile women who attended the “Infertility Management Center” from October 2018 to September 2019. All patients had HSG performed in the radiology department of different hospitals. Laparoscopic findings were used as a reference standard to analyze the findings of HSG for tubal occlusion. Data were analyzed by SPSS software (version 16).

Results: Normal HSG findings were seen in 53 patients (42.4%). Unilateral tubal occlusion was present in 38 (30.7%), and bilateral occlusion in 34 (27.2%) patients. Laparoscopy showed normal findings in 85 (68.0%) patients. Unilateral tubal occlusion was demonstrated in laparoscopy in 27 (21.6%) and bilateral tubal occlusion in 13 (10.4%) patients. HSG findings for diagnosis of tubal occlusion was true positive in 30 (24%) cases, false positive in 42 (33.6%) cases, false negative in 10 (8%) cases, and true negative in 43 (34.4%) cases in comparison to laparoscopy findings. Sensitivity of HSG was found to be 75.0%, specificity 50.6%, and accuracy 58.4%. Positive predictive value and negative predictive value were 41.7% and 81.1%, respectively.

Conclusion: HSG is widely used for tubal assessment in Bangladesh as it is a relatively inexpensive, low-risk office procedure. But it has a low specificity and positive predictive value with a relatively high negative predictive value. Laparoscopy, on the other hand, is preferable when there is high suspicion of tubal pathology.

Background: Follicular fluid meiosis-activating sterol (FFMAS) is one of several molecular compounds that has been added into in vitro maturation (IVM) technique with contradictory results. Our study aimed to investigate the effects of FFMAS in assisted reproductive technology (ART).

Methods: We searched systematically in PubMed, Web of Science, Scopus, Cochrane Registry of clinical trials, WHO registry of clinical trials, clinicaltrials.gov, Google Scholar until July 2017. Meta-analysis was used to investigate the efficacy and safety outcomes of FFMAS. Following the retrieval of potential articles, two independent reviewers screened and extracted included papers rigorously. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were computed for the individual outcome when data was available. Quality of included studies was assessed using Cochrane collaboration tool.

Results: A total of seven randomized controlled trials involving 1198 participants with 3105 oocytes were explored in this study. Most of the studies were at low risk of bias. Our random effects model meta-analyses in maturation and abnormal embryo rate between FFMAS-exposed oocytes compared with controls revealed no significant differences (summary OR 1.00, 95% CI 0.46–2.16, $p$ value = 0.99 and summary OR was 1.31, 95% CI 0.84–2.04, $p$ value = 0.23, respectively). Beside, our study showed a significant increase in uniformly abnormal embryo rate in FFMAS group compared with vehicle control group (summary OR 1.98, 95% CI 1.09–3.61, $p$ value = 0.03). No significances were noted on meta-analyses of normal embryo rate, uniformly abnormal embryo rate, uniformly normal embryo rate, mosaic embryo rate, abnormal blastomere rate, normal blastomere rate, aneuploidy mosaic embryo rate, and chaotic mosaic embryo rate.

Conclusions: FFMAS showed no efficacy in maturation process in human oocytes and there was some evidence for detrimental effects in comparison to vehicle controls. We discouraged any further trials due to safety concern.

Background: Asia Pacific Initiative on Reproduction (ASPIRE) aims to improve knowledge and awareness of Assisted Reproductive Technology (ART) and infertility-related services, with the aim of improving the quality of patient care.

Methods: A survey was developed and responded by a group of 10 ASPIRE board members to gather in-depth information about current practices, recommendations, and perceptions about SARS-CoV-2 and ART. The collected data were summarized and individual responses pooled among questions requiring voting. The overall rates were computed by response category. The group discussed the summary evidence, until a consensus was reached concerning a series of recommendation on how to make decisions concerning ART service provision during the current (and any future) pandemic. A two-tier recommendation was developed based on agreement rate and implementation priority. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were $\ge$60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” was >60%, but the rate of “absolutely agree” was $\le$50%.

Results: The survey was responded by all participants between July 24 and July 30, 2020. Nine tier 1 and five tier 2 recommendations are provided concerning prevention, testing, personal protective equipment, informed consent, and quality management. The former indicates the situations in which most individuals should receive the intervention/procedure, whereas the latter relates to those that may be suitable for individual clinics and patients.

Conclusions: This document provides the ASPIRE viewpoint on better managing infertile patients seeking ART during the COVID-19 pandemic. This expert opinion guide aims to help both competent authorities and healthcare providers to deliver quality and safe ART.

Oogenesis in mammalian females, including humans, is arrested prior to birth. Females, therefore, are born with a limited number of primary oocytes. This is in direct contrast to males in whom spermatogenesis continues during the entire lifespan following puberty. Here, we discuss possible evolutionary advantages that this confers and contrast this with age-related decline in oocyte quality that results in diminished fertility with advancing maternal age. We believe that a better understanding of these processes would be helpful in developing strategies to preserve fertility as maternal age increases, especially in the context of the current demographic shift with more and more women seeking fertility treatment at advanced age.

Objectives: To determine the correlation of subclinical hypothyroidism (SCH) with polycystic ovarian syndrome (PCOS) and to assess its impact on the clinical, biochemical and hormonal features in polycystic ovarian syndrome.

Background: PCOS is one of the most common endocrinopathies seen in women of the reproductive age group with a prevalence ranging from $2.2\%$ to $26\%$ globally (Joshi et al., 2014) and $3.7\%$ to $22.5\%$ (Malik et al., 2014) in the Indian population. Thyroid disorders are quite commonly seen in PCOS patients, SCH are seen in up to $5-10\%$ of this population (de Medeiros et al., 2018). Its association with PCOS has been insufficiently explored and therefore this study was designed to better understand the correlation.

Methodology: This was a cross-sectional study conducted from November 2019 to 2021 in the Department of Obstetrics and Gynecology of Jawaharlal Nehru Medical College and Hospital, Aligarh, India, on 150 PCOS women in the age bracket of 18–35 years. They were divided in two groups: one with normal thyroid levels and the other with SCH. Measurement of clinical, anthropometrical, biochemical and hormonal profile was made in both groups and comparison was made using appropriately matched tests of significance and coefficient of correlations.

Results: Notable findings included a positive and statistically significant correlation between SCH and menstrual cycle irregularities ($r=0.167$, $p<0.05$), infertility ($r=0.299$, $p<0.05$), body mass index ($r=0.172$, $p<0.05$), waist to hip ratio ($t\mathrm{\text{ value}}=-2.952$, $p<0.01$), testosterone($r=0.246$, $p<0.01$), total cholesterol ($r=0.205$, $p<0.05$), triglyceride values ($r=0.305$, $p<0.01$), fasting insulin ($r=0.219$, $p<0.01$) and HOMA-IR ($r=0.221$, $p<0.01$). A positive but statistically insignificant correlation was found with hirsutism ($r=0.116$, $p>0.05$), luteinizing hormone ($r=0.122$, $p>0.05$), follicle-stimulating hormone ($r=0.113$, $p>0.05$), prolactin levels ($r=0.109$, $p>0.05$), high-density lipoprotein ($r=0.050$, $p>0.05$), low-density lipoprotein ($r=0.136$, $p>0.05$) and fasting blood sugar values ($r=0.046$, $p>0.05$). No statistical significance with systolic blood pressure ($t\mathrm{\text{ value}}=-0.502$, $p>0.05$) and diastolic blood pressure ($t\mathrm{\text{ value}}=-1.643$, $p>0.05$) was found.

Conclusion: The study showed a significant correlation between SCH and multiple variables in PCOS and thereby necessitating thyroid screen in PCOS population.

Background: We compared the performance of follitropin delta and follitropin alfa in the gonadotropin-releasing hormone (GnRH) antagonist protocol for controlled ovarian stimulation (COS) and discussed the distinctive features of follitropin delta in COS.

Methods: Patients underwent COS using the GnRH antagonist protocol with either recombinant follicle-stimulating hormone (FSH) and oocytes were retrieved. We compared the results of COS, oocyte pick up, fertilization, embryo culture, and clinical pregnancy between the follitropin alfa group and the follitropin delta group.

Results: The serum estrogen level at trigger was significantly lower in the delta than in the alfa group (3,576.69 ± 1,775.60 vs. 2,833.19 ± 1,567.88) as was serum P4 level (2.14 ± 1.26 vs. 1.19 ± 0.85). The stimulation duration (in days) were longer (12.97 ± 2.38 vs. 13.96 ± 2.26) and total gonadotropin dose significantly lower (199.69 ± 54.47 vs. 114.27 ± 39.92), respectively, in the delta group than in the alfa group. The ovarian hyperstimulation syndrome (OHSS) rate was significantly lower in the delta than in the alfa group (48.1% vs. 58.6%). Fertilization, good blastocyst, and clinical pregnancy rates were not significantly different.

COS using follitropin delta is characterized by significantly slower follicle development than COS using follitropin alfa. A comparison of developing follicles showed that the minimum follicle was significantly smaller in the delta group on days 6–8 of COS. The maximum follicle was significantly smaller in the delta group on days 6–8 and 11–13 of COS. The number of follicles larger than 14 mm was significantly lower in the delta group on days 6–8 of COS.

Conclusions: Using follitropin delta is associated with slow follicular development, slow serum E2 elevation, and longer stimulation duration; however, excessive elevation of serum estrogen levels during COS is reduced and so is the incidence of mild OHSS.

We report the first documented case of recurrent implantation failure (RIF) related to morular endometrial metaplasia. A 35-year-old woman with RIF was diagnosed with endometrial morular metaplasia and treated with hysteroscopically guided excision allowing a live birth after the transfer of a single IVF embryo. Subtle endometrial changes, such as endometritis or bone metaplasia, have long been known to impair the success of embryo implantation, but this observation reports the first case of squamous morular endometrial metaplasia to be diagnosed and treated conservatively before a successful single embryo transfer.

Introduction: Polycystic ovarian syndrome is one of the most common causes of infertility in women of reproductive age. It is a combination of chronic anovulation, obesity, and hyperandrogenism that may affect sexual function in women of reproductive age.

Objectives: The study aimed to assess the sexual dysfunction, its frequency, and predisposing factors in infertile polycystic ovary syndrome (PCOS) patients.

Methods: This descriptive cross-sectional study was conducted among 240 infertile women with a definite diagnosis of PCOS. The study duration was 1 year, from August 2019 to August 2020. Data was collected chronologically by interview, physical examination, and laboratory investigations using a structured questionnaire. The presence of hirsutism was assessed using the modified Ferriman–Gallwey (mFG) scoring system. Sexual function was assessed in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain using the female sexual function index (FSFI). Patients were also assessed for mental health by the depression, anxiety, and stress scale-21 (DASS-21).

Results: Sexual dysfunction was present in 65.4% of patients with the domains of orgasm and arousal were particularly affected (92.9% and 90.0%, respectively). In this study, age and BMI had a significant negative correlation ($r$ = − 0.55 and $r$ = − 0.42, respectively) with sexual function. Increasing age and BMI resulted in a significant reduction in sexual function ( $P<$ 0.001 each), including all domains. Patients with symptoms of depression and anxiety were significantly more likely to suffer from sexual dysfunction than those without these symptoms ($P$ = 0.041 and $P$ = 0.001, respectively). Hirsutism, serum testosterone (total) level, and stress were found to have no significant effect on sexual function.

Conclusions: Infertile patients with PCOS markedly suffer from sexual dysfunction. Improvement of sexual dysfunction not only improves sexuality and quality of life, but also may improve fertility outcomes in infertile PCOS patients.

Background and Aims: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Mullerian hormone (AMH) and body mass index (BMI) for ovarian stimulation.

Methods: In this present manuscript, we aimed to gather all available data published between 2018–2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF).

Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Therefore, all post hoc derived analyzes and subgroups of patients who participated in subsequent studies support this statement.

Conclusion: Despite the relatively limited range of data in the current literature, most authors provide strong evidence to support the later use of this drug according to patient profiles and overcoming ethnic limitations. Others disagree with these observations, but this topic and this drug have great potential. As such, additional research is needed to fill existing knowledge gaps and extend this experience to a larger scale. Demonstrate overcoming all limitations.

Background: Impaired thyroid function may affect the follicular growth and development and reduces the number of follicles in ovaries. Thus, hypothyroidism may cause the reduction of ovarian reserve in women with reproductive age group. This study aimed to assess the ovarian reserve in infertile hypothyroid women.

Methods: This cross-sectional study was conducted in Reproductive Endocrinology and Infertility Unit, Dhaka Medical College Hospital, Bangladesh from July 2021 to June 2022. Total 167 hypothyroid infertile women of 20–35 years of age who had S. TSH level >2.5 mIU/L with normal/low free T4 were included. Ovarian reserve was evaluated by serum anti-Mullerian hormone (AMH) and antral follicle count (AFC). Thyroid autoimmunity was also assessed by measuring anti thyroid per oxidase antibody (TPOAb) and anti-thyroglobulin antibody (TgAb). Then the relationship of ovarian reserve, thyroid hormones and anti-thyroid antibodies were assessed.

Results: Among the 167 women with hypothyroidism, 124 (74.3%) patients had sub-clinical hypothyroidism (SCH) and rest 43 (25.7%) had overt hypothyroidism. Infertile women with overt hypothyroidism had significantly higher TPOAb(+) (67.4%) and TgAb (+) (46.5%) than those of subclinical hypothyroid women (TPOAb+ve : 29%, TgAb+ve : 29.8%, p-value: 0.014). Correlation analysis showed that there was significant negative correlation between AMH and TSH (r: −0.029, p-value: 0.024), TPOAb (r: −0.053, p value: 0.011), TgAb (r: −0.083, p-value: 0.018). Diminished ovarian reserve was significantly associated with overt hypothyroidism in this study population (p-value: 0.001). 33(26.6%) and 23(53.5%) of SCH and overt hypothyroid women had diminished ovarian reserve respectively.

Conclusion: Anti-Mullerian hormone was negatively associated with increased TSH level and with anti-thyroid antibodies (TPOAb and TgAb). Diminished ovarian reserve was significantly associated overt hypothyroidism. So, the study findings suggest that hypothyroidism has a negative effect on ovarian reserve.