title: Changes of endocrine and ultrasound markers as ovarian aging in modifying the Stages of Reproductive Aging Workshop (STRAW) staging system with subclassification of mid reproductive age stage.
abstract: OBJECTIVE
  To demonstrate the changes of ovarian aging markers across the Stages of Reproductive Aging Workshop (STRAW) stages and modify it with subclassification of mid reproductive age stage (MR).
  
  
  METHODS
  Healthy females were classified according to the STRAW system. Serum basal FSH, LH, E2, and anti-Müllerian hormone (AMH) were detected, FSH/LH ratio calculated, and antral follicle counts (AFCs) determined in follicular phase.
  
  
  RESULTS
  Progression through the whole STRAW stages under MR stage subdivided is associated with elevations in FSH, LH, FSH/LH ratio and decreases in E2, AMH and AFCs (p < 0.001). Both serum AMH and AFCs decreased early (after 25 years) and significantly (p < 0.01) with chronological age in MR stage. 0.982 ng/ml AMH and 3 antral follicles (low level of MR 25-30 years) were set as cutoffs to distinguish MR stage into early mid reproductive age (EMR) and late mid reproductive age (LMR) stages. The women in EMR stage compared with LMR could retrieve more oocytes in IVF treatment (p < 0.05) and has a higher pregnancy chance (57.9%) though not significant.
  
  
  CONCLUSIONS
  The early and marked fall in serum AMH levels and AFCs suggest fine markers to further categorize and define the MR stage, demonstrating disparate reproductive aging period with reduced ovarian reserve in young age across the STRAW stages.
authors: Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors: Ting
authors: T
authors: Ding
authors: Aiyue
authors: A
authors: Luo
authors: Jingjing
authors: J
authors: Jiang
authors: Xiaofang
authors: X
authors: Du
authors: Shuhong
authors: S
authors: Yang
authors: Zhiwen
authors: Z
authors: Lai
authors: Wei
authors: W
authors: Shen
authors: Yunping
authors: Y
authors: Lu
authors: Ding
authors: D
authors: Ma
authors: Shixuan
authors: S
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000097:blood / Q000502:physiology*; D054304:Anti-Mullerian Hormone / Q000097:blood; D015415:Biomarkers / Q000378:metabolism; D004958:Estradiol / Q000097:blood; D005260:Female; D043373:Follicle Stimulating Hormone, Human / Q000097:blood; D005498:Follicular Phase / Q000502:physiology; D012739:Gonadal Steroid Hormones / Q000097:blood*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008875:Middle Aged; D009865:Oocytes / Q000000981:diagnostic imaging / Q000502:physiology; D006080:Ovarian Follicle / Q000000981:diagnostic imaging* / Q000502:physiology*; D011247:Pregnancy; D018873:Pregnancy Rate; D012098:Reproduction / Q000502:physiology*; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D043373:Follicle Stimulating Hormone, Human; D012739:Gonadal Steroid Hormones; D004958:Estradiol; D054304:Anti-Mullerian Hormone; D007986:Luteinizing Hormone