Impact of Systemic Lupus Erythematosus on Ovarian Reserve in Premenopausal Women before Receiving Cyclophosphamide Therapy: Evaluation Using Anti-Müllerian Hormone

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease, which can negatively influence family planning in young women and usually manifests in women during their childbearing age. Treatment with cyclophosphamide in the acute phase can damage the ovaries, and may result in reduction or even loss of function. The ovarian function can also be reduced by autoimmune oophoritis in lupus patients. We analysed the influence of SLE in patients without previous cyclophosphamide therapy on the ovarian reserve against the disease intensity and duration of illness. Material and Methods: The ovarian reserve of 33 premenopausal SLE patients without previous cyclophosphamide treatment was determined by measuring the anti-Muellerian hormone (AMH) and was compared to the AMH values from 33 age-matched healthy controls. The number of children and miscarriages were also recorded in both groups. The SLE Activity Index (SLEDAI) and the European Consensus Lupus Activity Measurement (ECLAM) were used to evaluate disease activity and the duration of illness was taken into account. Results: The median AMH value in the lupus group was 2.15 (0.01 - 6.4) ng/ml versus 3.17 (0.33 - 8.82) ng/ml in the control group and thus significantly lower in the SLE group (p < 0.05). There was a trend to more miscarriages and less children in patients with SLE, but the differences were not significant. There was no correlation between the AMH value and the duration of illness or the SLEDAI as an indicator of disease activity. Conclusion: This is the first study to examine AMH levels in women with SLE without previous cyclophosphamid-therapy. Our study shows that despite mild disease activity (mean SLEDAI 2.27), the SLE patients had a significantly lower ovarian reserve than age-matched healthy women. This could be a sign that the disease itself has a negative influence on the ovarian reserve and therefore on family planning and conception. As cytotoxic therapy is still standard for some SLE manifestations this data is important information. Ovary protection before and during cytotoxic treatment is even more important in SLE patients.