Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Anti-Mullerian Hormone in Systemic Lupus Erythematodes Is Fertility Affected?

Henes1,  Joerg C., Henes4,  Melanie, Fehm4,  Tanja, Wallwiener4,  Diethelm, Kanz2,  Lothar, Koetter2,  Ina, Lawrenz3,  Barbara

Department for Internal Medicine II; University Hospital Tuebingen, Tuebingen, Germany
Department for Internal Medicine II; University Hospital Tuebingen, Germany
Department of Gynecology and Obstetrics; University Hospital of Tuebingen, Germany
Department of Gynecology and Obstetrics; University Hospital Tuebingen, Germany

Introduction:

Systemic lupus erythematodes (SLE) usually manifests in women during their childbearing age. Women with SLE have a lower number of births compared to healthy controls although fertility is considered not to be reduced. Anti-Mullerian hormone is expressed in granulosa cells of growing follicles, reflects the size of the primordial follicle pool and therefore is used to assess fertility potential.

Method:

Serum samples of 40 patients with SLE without previous cytotoxic – especially cyclophosphamid – treatment and 40 age matched, healthy controls were collected. All patients gave written informed consent and filled out a questionnaire on menstrual irregularities, lifestyle, pregnancy outcomes and contraception. AMH was quantified using a standard ELISA with standard value 1–8mg/l; values < 1mg/l defined as reduced, < 0,4mg/l as severely reduced fertility. Systemic lupus erythematosus disease activity index (SLEDAI) and European Consensus Lupus Activity Measurement (ECLAM) were used for clinical disease activity assessment.

Results:

Median age was 29,5 (20–39) years. Disease activity was low to moderate with a median SLEDAI of 2 (0–17) and ECLAM of 1,75 (0–5). The median AMH level was 1,7 (0,01 – 15mg/l) and thus lower compared to historic control groups with 2,1 and 2,3 (1). In 30% (12 patients) AMH level was below 1mg/l and in 6 even < 0,4m/l. 8 patients were pregnant at the time of sample acquisition and patients had an average of 0,55 children.

Discussion:

This is the first study to examine AMH levels in women with SLE. Lupus patients seem to have a reduced ovarian reserve and a reduced period of reproduction. As cytotoxic therapy is still standard for some SLE manifestations this data has an impact on fertility preservation strategies. Ovary protection during cytotoxic treatment is even more important in SLE patients.

Literature:

1.ParkLawsonChuanOberfieldHoegerWitchelChang, ASMASSSEKMSFRJ. Serum anti-mullerian hormone concentrations are elevated in oligomenorrheic girls without evidence of hyperandrogenism. J Clin Endocrinol Metab. 2010;95(4):1786–92.

2.DafopoulosDafopoulosGeorgouliasGalaziosLimberisTsikourasKoutlakiMaroulis, AKPGVPNG. Smoking and AMH levels in women with normal reproductive history. Arch Gynecol Obstet. 2010

To cite this abstract, please use the following information:
Henes, Joerg C., Henes, Melanie, Fehm, Tanja, Wallwiener, Diethelm, Kanz, Lothar, Koetter, Ina, et al; Anti-Mullerian Hormone in Systemic Lupus Erythematodes Is Fertility Affected? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1145
DOI: 10.1002/art.28911

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