Investigation of the Prevalence of Diminished Ovarian Reserve in Korean Women of Reproductive Age
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects
2.2. Definitions
2.3. Analytical Methods
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- World Health Organization. Infertility Prevalence Estimates, 1990–2021. Available online: https://www.who.int/publications/i/item/978920068315 (accessed on 18 April 2023).
- Steiner, A.Z.; Pritchard, D.; Stanczyk, F.Z.; Kesner, J.S.; Meadows, J.W.; Herring, A.H.; Baird, D.D. Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age. JAMA 2017, 318, 1367–1376. [Google Scholar] [CrossRef]
- Testing and interpreting measures of ovarian reserve: A committee opinion. Fertil. Steril. 2020, 114, 1151–1157. [CrossRef] [PubMed]
- Infertility Workup for the Women’s Health Specialist: ACOG Committee Opinion, Number 781. Obstet. Gynecol. 2019, 133, e377–e384. [CrossRef] [PubMed]
- Moolhuijsen, L.M.E.; Visser, J.A. Anti-Müllerian Hormone and Ovarian Reserve: Update on Assessing Ovarian Function. J. Clin. Endocrinol. Metab. 2020, 105, 3361–3373. [Google Scholar] [CrossRef] [PubMed]
- Liao, S.; Pan, W.; Dai, W.Q.; Jin, L.; Huang, G.; Wang, R.; Hu, C.; Pan, W.; Tu, H. Development of a Dynamic Diagnosis Grading System for Infertility Using Machine Learning. JAMA Netw. Open 2020, 3, e20236542020. [Google Scholar] [CrossRef]
- Carson, S.A.; Kallen, A.N. Diagnosis and Management of Infertility: A Review. JAMA 2021, 326, 65–76. [Google Scholar] [CrossRef]
- Deadmond, A.K.C.; Parry, J.P. Ovarian Reserve Testing. Endotext [Internet] 2022. Available online: https://www.ncbi.nlm.nih.gov/books/NBK279058/# (accessed on 18 April 2023).
- Kunicki, M.; La Marca, A.; Lainas, G.; Le Clef, N.; Massin, N.; Mastenbroek, S.; Polyzos, N.; Sunkara, S.K.; Timeva, T.; Töyli, M.; et al. ESHRE guideline: Ovarian stimulation for IVF/ICSI. Hum. Reprod. Open 2020, 2, hoaa009. [Google Scholar]
- Ministry of Health and Welfare. Korea. Mother and Child Health Service by Mother and Child Health Act. Available online: https://www.law.go.kr/LSW/lsInfoP.do?lsiSeq=216027&chrClsCd=010203&urlMode=engLsInfoR&viewCls=engLsInfoR#0000 (accessed on 18 April 2023).
- Yun, B.H.; Kim, G.; Park, S.H.; Noe, E.B.; Seo, S.K.; Cho, S.; Choi, Y.S.; Lee, B.S. In vitro fertilization outcome in women with diminished ovarian reserve. Obstet. Gynecol. Sci. 2017, 60, 46–52. [Google Scholar] [CrossRef]
- Ji, M.; Kim, K.R.; Kim, H.K.; Lee, W.; Yun, Y.M.; Chun, S.; Min, W.K. Age Group-specific Reference Intervals for the Elecsys Anti-Müllerian Hormone Assay in Healthy Korean Women: A Nationwide Population-based Study. Ann. Lab. Med. 2022, 42, 621–629. [Google Scholar] [CrossRef]
- Han, A.; Suh, B.; Yi, G.; Lee, Y.J.; Kim, S.E. Comparison of the Automated Fluorescent Immunoassay System With Roche Elecsys and Beckman Coulter Access 2 Assays for Anti-Mullerian Hormone Measurement. Ann. Lab. Med. 2022, 42, 47–53. [Google Scholar] [CrossRef]
- Jeong, H.G.; Kim, S.K.; Lee, J.R.; Jee, B.C. Correlation of oocyte number with serum anti-Müllerian hormone levels measured by either Access or Elecsys in fresh in vitro fertilization cycles. Clin. Exp. Reprod. Med. 2022, 49, 202–209. [Google Scholar] [CrossRef] [PubMed]
- Choi, R.; Lee, S.G.; Lee, E.H. Reference intervals of anti-Müllerian hormone in Korean women. J. Clin. Lab. Anal. 2022, 36, e245252022. [Google Scholar] [CrossRef] [PubMed]
- Clinical and Laboratory Standards Institute (CLSI). CLSI GP49-ED1:2017 Developing and Managing a Medical Laboratory (Test) Utilization Management Program, 1st ed.; Clinical and Laboratory Standards Institute (CLSI): Wayne, PA, USA, 2017. [Google Scholar]
- Choi, R.; Chun, G.; Park, M.J.; Lee, S.G.; Lee, E.H. Prevalence of Iron Deficiency Anemia Indicated for Intravenous Iron Treatment in the Korean Population. Nutrients 2023, 15, 614. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Women of Reproductive Age (15–49 Years) Population (Thousands). Available online: https://www.who.int/data/maternal-newborn-child-adolescent-ageing/indicator-explorer-new/mca/women-of-reproductive-age-(15-49-years)-population-(thousands) (accessed on 18 April 2023).
- Choi, R.; Chun, G.; Park, M.J.; Lee, S.G.; Lee, E.H. Utilization of Glucose-6-Phosphate Dehydrogenase Test and the Prevalence of Enzyme Deficiency in Korea. J. Clin. Med. 2023, 12, 3179. [Google Scholar] [CrossRef]
- Statistical Database. Korean Statistical Information Service (KOSIS). Statistics Korea. Available online: https://kosis.kr/index/index.do (accessed on 10 April 2023).
- Devine, K.; Mumford, S.L.; Wu, M.; DeCherney, A.H.; Hill, M.J.; Propst, A. Diminished ovarian reserve in the United States assisted reproductive technology population: Diagnostic trends among 181,536 cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. Fertil. Steril. 2015, 104, 612–619.e3. [Google Scholar] [CrossRef] [Green Version]
- Statistics Korea. Korean Standard Classification of Diseases, KCD, 7th. Available online: https://www.koicd.kr/kcd/kcds.do (accessed on 18 April 2023).
- Health Insurance Review & Assessment Service. Statistics for Test—D3730 Anti-Mullerian Hormone. Healthcare Bigdata Hub. Available online: http://opendata.hira.or.kr/op/opc/olapDiagBhvInfo.do (accessed on 11 April 2023).
- Health Insurance Review & Assessment Service. Statistics for Popular Diseases—No.110 Infertility. Healthcare Bigdata Hub. Available online: http://opendata.hira.or.kr/op/opc/olapMfrnIntrsIlnsInfo.do (accessed on 11 April 2023).
- Presidental Committee on Aging Society and Population Policy. Available online: http://www.betterfuture.go.kr/front/policySpace/basicPlan.do (accessed on 13 April 2023).
- Korea Population, Health and Welfare Association. Available online: http://www.ppfk.or.kr/en/sub/progrem/health.asp (accessed on 18 April 2023).
- Punchoo, R.; Bhoora, S. Variation in the Measurement of Anti-Müllerian Hormone—What Are the Laboratory Issues. Front. Endocrinol. 2021, 12, 719029. [Google Scholar] [CrossRef]
- Lee, M.; You, M. Avoidance of Healthcare Utilization in South Korea during the Coronavirus Disease 2019 (COVID-19) Pandemic. Int. J. Environ. Res. Public Health 2021, 18, 4363. [Google Scholar] [CrossRef]
- Daniluk, J.C.; Koert, E.; Cheung, A. Childless women’s knowledge of fertility and assisted human reproduction: Identifying the gaps. Fertil. Steril. 2012, 97, 420–426. [Google Scholar]
- Yin, W.W.; Huang, C.C.; Chen, Y.R.; Yu, D.Q.; Jin, M.; Feng, C. The effect of medication on serum anti-müllerian hormone (AMH) levels in women of reproductive age: A meta-analysis. BMC Endocr. Disord. 2022, 22, 158. [Google Scholar]
- Kang, E.; Yun, J.; Hwang, S.H.; Lee, H.; Lee, J.Y. The impact of the COVID-19 pandemic in the healthcare utilization in Korea: Analysis of a nationwide survey. J. Infect. Public Health 2022, 15, 915–921. [Google Scholar] [CrossRef]
- Mukherjee, T.I.; Khan, A.G.; Dasgupta, A.; Samari, G. Reproductive justice in the time of COVID-19: A systematic review of the indirect impacts of COVID-19 on sexual and reproductive health. Reprod. Health 2021, 18, 252. [Google Scholar] [CrossRef] [PubMed]
Variables | N | Min | 2.5th | 5th | 10th | 25th | Med | 75th | 90th | 95th | 97.5th | Max | Mean | SD |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Age | 13,351 | 20.0 | 21.7 | 23 | 25.2 | 30.0 | 35.9 | 43.2 | 47.1 | 48.4 | 49.0 | 49.9 | 36.2 | 7.97 |
Anti-Müllerian Hormone (ng/mL) | ||||||||||||||
20–24 years | 1280 | 0.01 | 1.05 | 1.69 | 2.34 | 3.72 | 5.78 | 8.63 | 12.30 | 15.15 | 18.00 | 23.00 | 6.70 | 4.16 |
25–29 years | 2049 | 0.01 | 0.75 | 1.21 | 1.77 | 3.23 | 5.13 | 7.88 | 11.60 | 14.61 | 17.20 | 23.00 | 6.10 | 4.20 |
30–34 years | 2874 | 0.01 | 0.33 | 0.63 | 1.20 | 2.24 | 3.79 | 6.17 | 9.19 | 11.58 | 14.77 | 23.00 | 4.69 | 3.60 |
35–39 years | 2269 | 0.01 | 0.01 | 0.12 | 0.36 | 1.03 | 2.14 | 3.76 | 5.79 | 7.31 | 9.44 | 23.00 | 2.79 | 2.60 |
40–44 years | 2456 | 0.01 | 0.01 | 0.01 | 0.01 | 0.11 | 0.54 | 1.35 | 2.55 | 3.82 | 4.92 | 19.70 | 1.03 | 1.45 |
45–49 years | 2423 | 0.01 | 0.01 | 0.01 | 0.01 | 0.01 | 0.08 | 0.30 | 0.75 | 1.05 | 1.52 | 5.70 | 0.26 | 0.45 |
Follicle-stimulating hormone (mIU/mL) | ||||||||||||||
20–24 years | 1280 | 0.3 | 1.5 | 1.8 | 2.7 | 4.4 | 5.8 | 7.0 | 8.1 | 8.9 | 9.8 | 59.6 | 5.8 | 2.8 |
25–29 years | 2049 | 0.3 | 1.5 | 2.1 | 2.8 | 4.4 | 5.8 | 7.1 | 8.3 | 9.3 | 10.5 | 116.0 | 6.1 | 5.4 |
30–34 years | 2874 | 0.3 | 1.7 | 2.3 | 3.1 | 4.7 | 6.2 | 7.5 | 8.9 | 10.2 | 13.2 | 134.0 | 6.7 | 6.6 |
35–39 years | 2269 | 0.3 | 1.8 | 2.3 | 2.9 | 4.7 | 6.4 | 8.2 | 11.3 | 17.4 | 41.1 | 200.0 | 8.7 | 13.1 |
40–44 years | 2456 | 0.3 | 2.0 | 2.4 | 3.1 | 4.7 | 7.1 | 12.8 | 45.8 | 73.9 | 90.3 | 200.0 | 16.0 | 23.5 |
45–49 years | 2423 | 0.3 | 0.0 | 2.7 | 3.6 | 5.8 | 11.5 | 37.5 | 74.5 | 93.6 | 106.0 | 165.0 | 26.0 | 29.9 |
Guide | Ovarian Reserve by Serum AMH and/or FSH | All Age (n = 13,351) | 20–24 Years (n = 1280) | 25–29 Years (n = 2049) | 30–34 Years (n = 2874) | 35–39 Years (n = 2269) | 40–44 Years (n = 2456) | 35–39 Years (n = 2423) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | n | % | n | % | n | % | ||
ACOG and ASRM | Normal (AMH ≥ 1.0 ng/mL and FSH ≤ 10.0 mIU/mL) | 8213 | 61.5 | 1231 | 96.2 | 1927 | 94.0 | 2557 | 89.0 | 1621 | 71.4 | 755 | 30.7 | 122 | 5.0 |
DOR by AMH only (AMH < 1.0 ng/mL and FSH ≤ 10.0 mIU/mL) | 2487 | 18.6 | 24 | 1.9 | 56 | 2.7 | 160 | 5.6 | 337 | 14.9 | 917 | 37.3 | 993 | 41.0 | |
DOR by FSH only (AMH ≥ 1.0 ng/mL and FSH > 10.0 mIU/mL) | 329 | 2.5 | 20 | 1.6 | 47 | 2.3 | 85 | 3.0 | 97 | 4.3 | 63 | 2.6 | 17 | 0.7 | |
DOR by both AMH and FSH (AMH < 1.0 ng/mL and FSH > 10.0 mIU/mL) | 2322 | 17.4 | 5 | 0.4 | 19 | 0.9 | 72 | 2.5 | 214 | 9.4 | 721 | 29.4 | 1291 | 53.3 | |
DOR by any of AMH or FSH (AMH < 1.0 ng/mL or FSH > 10.0 mIU/mL) | 5138 | 38.5 | 49 | 3.8 | 122 | 6.0 | 317 | 11.0 | 648 | 28.6 | 1701 | 69.3 | 2301 | 95.0 | |
Korean | Normal (AMH > 1.0 ng/mL and FSH ≥ 12.0 mIU/mL) | 8380 | 62.8 | 1244 | 97.2 | 1957 | 95.5 | 2605 | 90.6 | 1665 | 73.4 | 782 | 31.8 | 127 | 5.2 |
DOR by AMH only (AMH ≤ 1.0 ng/mL and FSH < 12.0 mIU/mL) | 2800 | 21.0 | 24 | 1.9 | 61 | 3.0 | 177 | 6.2 | 403 | 17.8 | 1021 | 41.6 | 1114 | 46.0 | |
DOR by FSH only (AMH > 1.0 ng/mL and FSH ≥ 12.0 mIU/mL) | 142 | 1.1 | 7 | 0.5 | 15 | 0.7 | 36 | 1.3 | 45 | 2.0 | 33 | 1.3 | 6 | 0.2 | |
DOR by both AMH and FSH (AMH ≤ 1.0 ng/mL and FSH ≥ 12.0 mIU/mL) | 2029 | 15.2 | 5 | 0.4 | 16 | 0.8 | 56 | 1.9 | 156 | 6.9 | 620 | 25.2 | 1176 | 48.5 | |
DOR by any of AMH or FSH (AMH ≤ 1.0 ng/mL or FSH ≥ 12.0 mIU/mL) | 4971 | 37.2 | 36 | 2.8 | 92 | 4.5 | 269 | 9.4 | 604 | 26.6 | 1674 | 68.2 | 2296 | 94.8 |
Characteristics | No. of Tested Women | Diminished Ovarian Reserve 1 | No. of Residents | ||
---|---|---|---|---|---|
N | Prevalence (%) | Age-Adjusted Prevalence (%) | |||
Total | 13,351 | 4971 | 37.2 | 38.4 | 10,273,563 |
20–24 years | 1280 | 36 | 2.8 | 1,449,453 | |
25–29 years | 2049 | 92 | 4.5 | 1,651,173 | |
30–34 years | 2874 | 269 | 9.4 | 1,553,373 | |
35–39 years | 2269 | 604 | 26.6 | 1,650,151 | |
40–44 years | 2456 | 1674 | 68.2 | 1,956,066 | |
45–49 years | 2423 | 2296 | 94.8 | 2,013,347 | |
Seoul, Gyeonggi-do, and Incheon | 10,875 | 4068 | 37.4 | 38.2 | 5,638,653 |
20–24 years | 1005 | 28 | 2.8 | 782,962 | |
25–29 years | 1706 | 75 | 4.4 | 961,554 | |
30–34 years | 2273 | 202 | 8.9 | 901,312 | |
35–39 years | 1864 | 496 | 26.6 | 909,856 | |
40–44 years | 2041 | 1387 | 68.0 | 1,037,250 | |
45–49 years | 1986 | 1880 | 94.7 | 1,045,720 | |
Jeolla province | 940 | 353 | 37.6 | 36.6 | 886,905 |
20–24 years | 103 | 1 | 1.0 | 138,289 | |
25–29 years | 92 | 5 | 5.4 | 134,352 | |
30–34 years | 212 | 18 | 8.5 | 119,079 | |
35–39 years | 171 | 43 | 25.2 | 137,057 | |
40–44 years | 169 | 106 | 68.7 | 171,465 | |
45–49 years | 193 | 180 | 93.3 | 186,664 | |
Chungcheong province | 768 | 304 | 39.6 | 40.4 | 1,048,157 |
20–24 years | 48 | 1 | 2.1 | 148,857 | |
25–29 years | 100 | 5 | 5.0 | 157,077 | |
30–34 years | 220 | 28 | 12.7 | 152,929 | |
35–39 years | 125 | 32 | 25.6 | 172,280 | |
40–44 years | 130 | 100 | 76.9 | 205,387 | |
45–49 years | 145 | 138 | 95.2 | 211,629 | |
Gangwon-do | 431 | 75 | 17.4 | 38.2 | 257,199 |
20–24 years | 100 | 5 | 5.0 | 38,301 | |
25–29 years | 115 | 5 | 4.4 | 37,133 | |
30–34 years | 106 | 11 | 10.4 | 35,925 | |
35–39 years | 54 | 14 | 25.9 | 39,971 | |
40–44 years | 40 | 24 | 60.0 | 50,578 | |
45–49 years | 16 | 16 | 100.0 | 55,292 | |
Gyeongsang province | 337 | 171 | 50.7 | 43.1 | 2,311,737 |
20–24 years | 24 | 1 | 4.2 | 323,212 | |
25–29 years | 36 | 2 | 5.6 | 341,687 | |
30–34 years | 63 | 10 | 15.9 | 325,970 | |
35–39 years | 55 | 19 | 34.6 | 369,443 | |
40–44 years | 76 | 57 | 75.0 | 464,466 | |
45–49 years | 83 | 82 | 98.8 | 486,960 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Choi, R.; Park, W.; Chun, G.; Lee, S.G.; Lee, E.H. Investigation of the Prevalence of Diminished Ovarian Reserve in Korean Women of Reproductive Age. J. Clin. Med. 2023, 12, 5099. https://doi.org/10.3390/jcm12155099
Choi R, Park W, Chun G, Lee SG, Lee EH. Investigation of the Prevalence of Diminished Ovarian Reserve in Korean Women of Reproductive Age. Journal of Clinical Medicine. 2023; 12(15):5099. https://doi.org/10.3390/jcm12155099
Chicago/Turabian StyleChoi, Rihwa, Wonseo Park, Gayoung Chun, Sang Gon Lee, and Eun Hee Lee. 2023. "Investigation of the Prevalence of Diminished Ovarian Reserve in Korean Women of Reproductive Age" Journal of Clinical Medicine 12, no. 15: 5099. https://doi.org/10.3390/jcm12155099
APA StyleChoi, R., Park, W., Chun, G., Lee, S. G., & Lee, E. H. (2023). Investigation of the Prevalence of Diminished Ovarian Reserve in Korean Women of Reproductive Age. Journal of Clinical Medicine, 12(15), 5099. https://doi.org/10.3390/jcm12155099