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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.

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.

This study investigated the effects of platelet-rich plasma (PRP) treatment on ovarian function and pregnancy outcomes in three patients with severe reduction of ovarian reserve. The patients had previously undergone multiple cycles of assisted reproductive technology (ART) without favorable results. Prior to PRP treatment, follicle-stimulating hormone (FSH), estradiol (E2), and anti-Mullerian hormone (AMH) levels were assessed. PRP was administered through intraovarian injection. Hormonal assessments were performed at 6–7 months after the first PRP injection. The results showed major improvements in ovarian function, as evidenced by decreased FSH levels and increased AMH levels in all three patients. The number of mature oocytes retrieved per cycle and the ovum-to-blastocyst rate were also improved. All the patients achieved successful pregnancies and gave birth to healthy infants. These findings suggest that PRP may enhance ovarian function, oocyte quality, and pregnancy outcomes in patients with severely reduced ovarian reserve. Further research is necessary to validate these results and explore the underlying mechanisms.