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Research article
Fecundity disorders in older women: declines in follicular development and endometrial receptivity
Xiaofeng Yang
The First Affiliated Hospital of Xi'an Jiaotong University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7631-4984
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background : Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women.
Methods: For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women.
Results: The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%).
Conclusions: Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.
Keywords
Older women, Fecundity, Endometrial receptivity, Implantation window, Ultrasonic parameters
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CURRENT STATUS: Under Review
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Editorial decision: Minor revision
On 20 May, 2020
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On 06 May, 2020
Editor invited
On 05 May, 2020
Submission checks complete
On 09 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 06 Apr, 2020
Review #1 received
Received 04 Apr, 2020
Reviewer #2 agreed
On 30 Mar, 2020
Review #2 received
Received 30 Mar, 2020
Reviewer #1 agreed
On 29 Mar, 2020
Reviewers invited
Invitations sent on 27 Mar, 2020
Editor assigned
On 03 Mar, 2020
Submission checks complete
On 02 Mar, 2020
Editor invited
On 02 Mar, 2020
No comments provided
Editorial decision: Major revision
On 23 Feb, 2020
Review #2 received
Received 21 Feb, 2020
Review #1 received
Received 05 Feb, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Reviewer #1 agreed
On 07 Jan, 2020
Reviewers invited
Invitations sent on 04 Jan, 2020
Editor assigned
On 19 Dec, 2019
Submission checks complete
On 18 Dec, 2019
Editor invited
On 18 Dec, 2019
First submitted
On 17 Dec, 2019
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PDF Downloads: ...
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Subject Areas
Obstetrics & Gynecology
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This preprint is under consideration at BMC Women's Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Fecundity disorders in older women: declines in follicular development and endometrial receptivity
Xiaofeng Yang
The First Affiliated Hospital of Xi'an Jiaotong University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7631-4984
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 14 Apr, 2020
No community comments so far
Editorial decision: Minor revision
On 20 May, 2020
Editor assigned
On 06 May, 2020
Editor invited
On 05 May, 2020
Submission checks complete
On 09 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 06 Apr, 2020
Review #1 received
Received 04 Apr, 2020
Reviewer #2 agreed
On 30 Mar, 2020
Review #2 received
Received 30 Mar, 2020
Reviewer #1 agreed
On 29 Mar, 2020
Reviewers invited
Invitations sent on 27 Mar, 2020
Editor assigned
On 03 Mar, 2020
Submission checks complete
On 02 Mar, 2020
Editor invited
On 02 Mar, 2020
No comments provided
Editorial decision: Major revision
On 23 Feb, 2020
Review #2 received
Received 21 Feb, 2020
Review #1 received
Received 05 Feb, 2020
Reviewer #2 agreed
On 21 Jan, 2020
Reviewer #1 agreed
On 07 Jan, 2020
Reviewers invited
Invitations sent on 04 Jan, 2020
Editor assigned
On 19 Dec, 2019
Submission checks complete
On 18 Dec, 2019
Editor invited
On 18 Dec, 2019
First submitted
On 17 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Obstetrics & Gynecology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background : Little research is available on follicular development and endometrial receptivity in older women. This study aimed to assess follicular development and endometrial receptivity, and to evaluate ultrasonic parameters in predicting endometrial receptivity during the implantation window in older women.
Methods: For this prospective case-control study, 224 older women and 215 young women were recruited. The follicular development and endometrial thickness were monitored by transvaginal ultrasound. During the implantation window, the pulsatility index (PI) and resistance index (RI) of the uterine arteries and subendometrial region, endometrial volume, vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were calculated between the two groups. The ultrasonic parameters were used to assess endometrial receptivity in older women.
Results: The serum anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC) were significantly lower in older women than in young women. The average diameter of the dominant follicle on days 14, 16, and 18 of the menstrual cycle were significantly smaller, and the subendometrial region RI on days 12, 14, 16, and 18 of the menstrual cycle were significantly higher in older women than in young women. The normal ovulation rate was significantly lower in older women than in young women. The subendometrial region RI was significantly higher, and the endometrial VI, FI, and VFI were significantly lower in older women compared with young women. The biochemical pregnancy rate, clinical pregnancy rate and ongoing pregnancy rate of older women were significantly lower than in young women. The best ultrasonic parameter for predicting endometrial receptivity during the implantation window in older women was VI (AUC =0.889, sensitivity 92.6% and specificity 85.4%).
Conclusions: Older women present decreased serum AMH concentrations and AFC, defined as indicators of ovarian reserve function. Older women are characterized by decreased follicular development and endometrial receptivity, which may lead to fecundity disorders.
Figure 1
Figure 2
Figure 3