OBJECTIVE To evaluate the association between diminished ovarian reserve (DOR) in women at risk of recurrent pregnancy loss (RPL) using ovarian reserve tests. DESIGN Systematic review and meta-analysis. SETTING University medical schools. PATIENT(S) Women with a history of RPL. INTERVENTION(S) Systematic reviews of major electronic databases (MEDLINE, EMBASE, Web of Science, and Scopus) for studies that evaluated the incidence of DOR in women with RPL. MAIN OUTCOME MEASURE(S) Association between RPL and DOR. RESULT(S) In studies up to May 2019 we assessed quality using the Newcastle-Ottawa Scale and meta-analyzed data using a random-effect model. We included 15 studies (n = 3,082 women) reporting on six ovarian reserve tests: antimüllerian hormone [AMH], antral follicle count, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and FSH:LH ratio. More women with RPL seemed to have DOR compared with women who did not have RPL as measured by low AMH levels (odds ratio [OR] 2.77; 95% confidence interval [CI], 1.41-5.46) and AFC (OR 2.45; 95% CI, 1.16-5.19). Women with unexplained RPL also seemed to have a higher association with DOR compared with women whose RPL had a known etiology, as measured by low AMH levels (OR 3.23; 95% CI, 1.81-5.76). No statistically significant differences were found in the levels of any of the remaining ovarian reserve tests between those groups of women. CONCLUSION(S) There is an apparent association between DOR and RPL. Low AMH and AFC levels could predict higher odds for pregnancy loss, but more studies are needed to evaluate their prognostic value in the management of women with RPL. SYSTEMATIC REVIEW REGISTRATION NUMBER Prospero CRD42018114673.

中文翻译：

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复发性流产中卵巢储备减少：系统评价和荟萃分析

目的 使用卵巢储备试验评估有复发性流产 (RPL) 风险的女性卵巢储备减少 (DOR) 之间的关联。设计系统评价和荟萃分析。设置大学医学院。患者 (S) 有 RPL 病史的女性。干预 对主要电子数据库（MEDLINE、EMBASE、Web of Science 和 Scopus）的系统评价，用于评估 RPL 女性 DOR 发生率的研究。主要结果测量 RPL 和 DOR 之间的关联。结果 在截至 2019 年 5 月的研究中，我们使用纽卡斯尔-渥太华量表评估质量，并使用随机效应模型对数据进行元分析。我们纳入了 15 项研究（n = 3,082 名女性），报告了六项卵巢储备测试：抗苗勒管激素 [AMH]、窦卵泡计数、促卵泡激素 (FSH)、促黄体激素 (LH)、雌二醇、和 FSH:LH 比率。通过低 AMH 水平（优势比 [OR] 2.77；95% 置信区间 [CI]，1.41-5.46）和 AFC（OR 2.45；95% CI，1.16-5.19）。与 RPL 具有已知病因的女性相比，不明原因的 RPL 女性与 DOR 的相关性似乎也更高，根据低 AMH 水平衡量（OR 3.23；95% CI，1.81-5.76）。这些妇女组之间的任何剩余卵巢储备测试的水平没有发现统计学上的显着差异。结论 (S) DOR 和 RPL 之间存在明显的关联。低 AMH 和 AFC 水平可以预测更高的流产几率，但需要更多的研究来评估它们在 RPL 女性治疗中的预后价值。