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Disentangling unexplained infertility and age‐related infertility Rate of false positive diagnoses of unexplained infertility according to age at initiation of pregnancy seeking Somigliana 2016 Inaccuracy of the diagnosis of unexplained infertility as women’s age increases Unfortunately, we do not have any useful support from biomarkers of age‐related infertility Tests of ovarian reserve Ovarian reserve does not affect natural fecundity provided that it is not severely compromised. Use a woman's age as an initial predictor of her overall chance of success through natural conception or with WHOM IVF (NICE) WHY Women at increased risk of diminished ovarian reserve: 1. 2. 3. 4. 5. 6. > 35 years; Family history of early menopause; Single ovary or history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy; Unexplained infertility Previous poor response to gonadotropin stimulation; Prior to ART treatment (Sharara FI, Am J Obstet Gynecol 1998) WHAT TO BE AVOIDED JUST ONE Cycle Day 3 FSH and Estradiol: significant intra‐ and intercycle variability Clomiphene Citrate Challenge Test (Only ASRM) Antral Follicle Count AMH (The Practice Committee of the American Society for Reproductive Medicine 2012, NICE guidelines) Quite limited in their accuracy to predict the chances of spontaneous conception! To predict response to ovarian stimulation with exogenous gonadotropins and, to a lesser extent, the likelihood for achieving a successful pregnancy with ART (Broekmans FJ et al, Hum Reprod Update 2006 Maheshwari A, Hum Reprod 2006). Do not use any of the following tests individually to predict any outcome of fertility treatment: •ovarian volume •ovarian blood flow •inhibin B •oestradiol (E2). (NICE Guidelines) 24 PRECONGRESS COURSE 09 I VIENNA, AUSTRIA – 23 JUNE 2019 27