46 IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Volume : 5 | Issue : 6 | June 2016 • ISSN No 2277 - 8179 | IF : 3.508 | IC Value : 69.48 Research Paper Medical Science Dr.Shachi Shukla Resident, Department of Obstetrics & Gynaecology, SMS Medical College, Jaipur. To Study The Efect of Age And BMI on Markers of Ovarian Reserve in Indian Women with Primary Infertility of Age >35 Years KEYWORDS : age, BMI, ovarian reserve, infertility. ABSTRACT Objective:-To study the efect of age and BMI on transvaginal USG and hormonal markers of ovarian reserve and to correlate USG markers with hormonal markers. Methodology: Fifty women with primary infertility of age >35 years having regular monthly cycles and no history of ovarian surgery were included in this cross-sectional study conducted from December 2010 until July 2011 in SMS Medical College. A transvaginal ul- trasound to ind out ovarian volume and antral follicles (AFC) and; blood tests for serum Follicle Stimulating Hormone (s.FSH) & serum. AntiMullerian Hormone (s.AMH) were carried out between the third and ifth day of their menstrual cycle. Results: s.FSH increases with increasing age; and s.AMH, ovarian volume and antral follicle count decreases with increasing age (p value<0.05). No signiicant efect of BMI on s.FSH, s.AMH, ovarian volume and antral follicle count (p value > 0.05) was seen. There is highly signiicant negative correlation between s.FSH and ovarian volume & s.FSH and AFC.There is highly signiicant positive correla- tion between s.AMH and ovarian volume & s.AMH and AFC Conclusion:-Age has signiicant efect on s.AMH, s.FSH, ovarian volume and antral follicle count while BMI does not signiicantly af- fect these markers. S.FSH increases with decreasing ovarian volume and antral follicle count while s.AMH decreases with decreasing ovarian volume and antral follicle count. Introduction Ovarian reserve is an indication of repro- ductive age as opposed to chronological age and is a parameter of calculating remaining reproductive lifes- pan of woman. Diminished ovarian reserve is character- ized by decreased number of remaining oocytes in the ovaries and impaired preantral oocytes development and recruitment. Over the past two decades, a number of tests of ovarian reserve have been used to determine follicle number and quality; and to predict the outcome of assisted reproduction procedures. The woman’s age and assays of serum FSH in the early follicular phase were amongst the earliest and most useful parameters used for evaluation of ovarian reserve. Several ultra- sound parameters have been used for evaluation of ovarian reserve, including ovarian volume, ovarian blood flow and the antral follicle count, with varying degrees of reliability. Recently, serum antimüllerian hormone levels have been introduced as a novel meas- ure of ovarian reserve. AMH is a product of the granu- losa cells in preantral and antral follicles. Serum AMH levels decline with age and are correlated with the number of antral follicles and the ovarian response to hyperstimulation. The present study is intended to evaluate the effect of age and BMI on hormonal and USG markers of ovarian reserve and to correlate USG markers with hormonal markers. Material and Method: This study was conducted in department of Obstetrics and Gynaecology, Sawai Man Singh Medical College, Jaipur between December 2010 to July 2011 on first 50 women coming for manage- ment of primary infertility who were >35 yrs. of age with regular menstrual cycles(excluding Male factor infertility, Tubal factor, Presence of gynaecological dis- orders such as menorrhagia or DUB, History of ovarian surgery & other causes of infertility).The study was ap- proved by ethical committee and research review board of Sawai Man Singh Medical College, Jaipur. Every case gave informed written consent prior to participation in the study. Cases were called on early follicular phase of menstrual cycle (day 1-3) and un- derwent transvaginal USG and Blood Tests. All Trans- vaginal USG was carried out by Toshiba Echo C using 7.5 MHz vaginal probe. The length, height and width of each ovary was measured in sagittal and coronal plane during TVS scanning and ovarian volume was obtained using formula of ellipsoid i.e., π/6 x (length x height x width).The number of antral follicles <10 mm in each ovary were counted. Blood samples were taken for measurement of s.FSH and s.AMH .s.FSH was measured by standard MICT R FSH test kit-Magnetic Immunochromatic test-sensitivity 0.2mIU/ml and s.AMH was measured by ELISA (B.Lal laboratories diagnostic analytical sensitivity 0.2ng/ml) Case’s height (m) and weight (kg) were recorded and BMI calculated (kg/m2).The cases demographic infor- mation was recorded on predesigned schedule (religion/ address/educational status/social status/medical &per- sonal history).Other causes of primary infertility were excluded by obtaining history, doing clinical examina- tion and standard diagnostic tests. Results. Women >35 years with primary infertility were includ- ed in the study according to age group they are divided into 3 groups i.e., 35-38 years,39-42 years & ≥43 years and then mean s.FSH, s.AMH, ovarian volume and an- tral follicle count taken out for particular age group and then standard deviation calculated and then level of significance calculated by ANOVA test. Significant effect of age was found over s.FSH, s.AMH, ovarian volume and antral follicle count. Thus s.FSH increases with increasing age; and s.AMH, ovarian volume and antral follicle count decreases with increasing age (p value<0.05) as shown in Table 1 below. Cases were divided according to BMI into 2 groups as ≤25 and>25 and then mean & standard deviation of FSH, AMH, ovarian volume and antral follicle count calculated for particular BMI and then level of sig- nificance of effect of BMI on these markers. This study shows no significant effect of BMI on s.FSH, s.AMH, ovarian volume and antral follicle count (p value > 0.05) as shown in Table 1 below. There is highly significant negative correlation between s.FSH and ovarian volume & s.FSH and AFC as shown in Table 2 below.