Ovarian reserve and stimulation response in patients with Mayer–Rokitansky–Kuster–Hauser syndrome

Mayer–Rokitansky–Kuster–Hauser syndrome (MRKHs), or Mullerian agenesis, is a congenital disorder characterized by the absence or underdevelopment of the uterus and upper vagina. It remains a leading cause of primary amenorrhea, presenting significant reproductive challenges. Although normal ovarian function is typical, optimal ovarian stimulation protocols and ovarian reserve in MRKHs patients are not well defined. This study aimed to assess ovarian reserve and response to ovarian stimulation in MRKHs patients, comparing their outcomes to women with male-factor infertility. In this retrospective study, we reviewed ovarian stimulation cycles from 52 MRKHs patients treated at Royan Institute, Tehran, Iran. A control group of 208 women with male-factor infertility was included. Demographic data, hormonal levels [anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH)], ovarian stimulation parameters, and embryo transfer outcome were analyzed using SPSS version 22, with paired t -tests and Chi-square tests to evaluate group differences. MRKHs patients required higher gonadotropin doses ( P= 0.001) and exhibited elevated mean LH levels (8.3 IU/L) compared to controls (4.4 IU/L, P= 0.001). However, no significant differences were observed in FSH and AMH levels. The total number of retrieved oocytes was significantly lower in the MRKHs group ( P= 0.005); however, the oocyte maturation rate was comparable between the two groups. The total number of embryos obtained and the high-quality embryo rate did not differ significantly between the groups. Pregnancy outcomes, including implantation rate, clinical pregnancy, miscarriage, live birth, and preterm labor rates, did not differ significantly between the groups. Pregnancy complications, including gestational diabetes mellitus and gestational hypertension, were observed only in the control group. No fetal or neonatal anomalies were reported in either group. Elevated LH levels in MRKHs suggest possible hyperandrogenemia unrelated to polycystic ovary syndrome. The altered ovarian response underscores the need for individualized ovarian stimulation protocols, potentially involving androgen-lowering treatments. Early oocyte or embryo cryopreservation is recommended to mitigate age-related decline in ovarian reserve, especially when gestational surrogacy is not immediately available.