Diminished ovarian reserve and adverse reproductive outcomes: Epidemiologic studies on their association

Talita de Carvalho Honorato

    Research output: ThesisThesis fully internal (DIV)

    1257 Downloads (Pure)


    Starting a family later in life is a trend of the last decades. For women, delaying childbearing to their mid-thirties means trying to conceive in a period in which fecundity, i.e., the capacity to conceive is already declining. The decline in the capacity to conceive is associated with the loss of oocytes, the female germline cells. Women are born with a fixed number of oocytes and throughout their lifespan these oocytes are lost via ovulation or cell death. Eventually, the loss of oocytes results in menopause. The remaining number of oocytes of a woman to a certain time point is known as her ovarian reserve. As oocytes age, their quality diminishes, as can be inferred from a higher frequency of trisomic pregnancies or a miscarriages at older maternal age.

    Whether the loss of quantity of oocytes is associated with the loss of quality of oocytes is still under debate. This thesis tests the hypothesis that diminished ovarian reserve is associated with lower quality of the remaining oocytes, leading to an increased risk of miscarriage and trisomic pregnancy.

    In this thesis, three proxies are used for diminished ovarian reserve: 1) ovarian surgery, 2) a low oocyte yield in IVF treatment after controlled ovarian stimulation, and 3) in-utero cigarette smoke exposure, i.e., smoking of the mother while pregnant of the woman who is now under study. Trisomic pregnancy and miscarriage are used as proxies for the quality of the oocytes. Additionally, we hypothesized that in-utero cigarette smoke exposure, resulting in a reduction of the ovarian reserve, is associated with age at menopause later in the life of the women who were exposed in-utero.
    Translated title of the contributionVerminderde ovariele reserve en ongustige uitkomsten: Epidemiologische studies over hun associatie
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • Hoek, Annemieke, Supervisor
    • Boezen, Hendrika, Supervisor
    • Groen, Henk, Co-supervisor
    • Haadsma, Maaike, Co-supervisor
    Award date9-Oct-2017
    Place of Publication[Groningen]
    Print ISBNs9789403401263
    Electronic ISBNs9789403401256
    Publication statusPublished - 2017

    Cite this