Fertility and Pregnancy Outcomes in Systemic Lupus Erythematosus Patients: A Study Using Antimullerian Hormone
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Abstract
Background: Systemic lupus Erthymatosus (SLE) affects predominantly women of reproductive age, and can lead to both negative effect on their fertility and adverse pregnancy outcomes. Antimullerian hormone (AMH) serum levels have been found to be a reliable marker of ovarian reserve.
Objectives: This research aimed to assess ovarian reserve by measuring AMH level in premenopausal SLE patients and to study different factors that can have an effect on it, and also to evaluate pregnancy outcomes in SLE patients.
Methods: The study was performed on 60 subjects divided into 2 groups; (I): 30 SLE female patients and (II): control group which includes 30 healthy female subjects. Full history taking and examination were carried out including assessment of disease activity by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) score and damage index by Systemic Lupus International Collaborating Clinics American College of Rheumatology Damage index (SLICC/ACR) on SLE patients, pregnancy questionnaire were used for taking history of the pregnancy outcomes. AMH levels were measured in both groups using AMH Gen II ELISA kits.
Results: There was no statistically significant difference between both groups as regard to median AMH levels and there was no statistically significant correlation between AMH and disease duration, BMI, SLEDAI-2K activity score, damage index and the immunosuppressive drugs such as cyclophosphamide, mycophenolate mofetil and azathioprine. There was statistically significant difference between both groups as regards to occurrence of miscarriage (P<0.0166) and hypertension in pregnancy (P<0.04).
Conclusion: From these results we can conclude that AMH values did not differ between SLE patients and healthy subjects, and the disease duration and/or activity did not affect its level. Moreover, the study reflected that immunosuppressive agents such as cyclophosphamide, azathioprine and mycophenolate mofetil did not affect the fertility in SLE patients. However, it was noted that adverse pregnancy outcomes were relatively more common in SLE patients, namely hypertension in pregnancy and miscarriages.
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References
2. Fischer-Betz R and Specker C (2017): Pregnancy in systemic lupus erythematosus and antiphospholipid syndrome, Best Practice & Research Clinical Rheumatology. 31: 397–414.
3. Al Arfaj A and Khalil N (2014): Fertility, ovarian failure, and pregnancy outcome in SLE patients treated with intravenous cyclophosphamide in Saudi Arabia. Clin Rheumatol, 33:1731–1736.
4. Ioannidis J, Katsifis G, Tzioufas A, et al., (2002): Predictors of sustained amenorrhea from pulsed intravenous cyclophosphamide in premenopausal women with systemic lupus erythematosus. J Rheumatol 29:2129–2135
5. Park Y, Jung S, Chung I, et al., (2004): Risk of ovarian failure and pregnancy outcome in patients with lupus nephritis treated with intravenous cyclophosphamide pulse therapy. Lupus 13(8):569–574
6. Leroy C, Rigot J, Leroy M et al. (2015): Immunosuppressive drugs and fertility. Orphanet Journal of Rare Diseases, 10, 136.
7. Cleary B, and Källén B (2009): Early pregnancy azathioprine use and pregnancy outcomes. Birth Research Defects 85: 647-54.
8. Petri M, Orbai A, Alarcón G, et al. (2012): Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum, 64(8):2677-2686.
9. Gladman D, Ibanez D and Urowitz M (2002): Systemic lupus erythematosus disease activity index. J Rheumatol. 29(2):288-291.
10. Gladman D, Ginzler E, Goldsmith C,et al., (1996): The development and initial validation of the Systemic lupus International Collaborating Clinics/ American Collage of Rheumatology (SLICC/ACR) Damage Index for Systemic lupus erythromatosus. Arthritis and Rheumatism, Vol. 39, No 3.
11. Yuen S, Krizova A, Ouimet J, et al. (2008): Pregnancy Outcome in Systemic Lupus Erythematosus (SLE) is Improving: Results from a Case Control Study and Literature Review. The Open Rheumatology Journal, 2, 89–98.
12. Anti-Müllerian Hormone (AMH) Assays Access AMH, https://www.beckmancoulter.com/en/products/immunoassay/access-amh
13. Ulug P, Oner G, Kasap B, et al. (2014): Evaluation of ovarian reserve tests in women with systemic lupus erythematosus. Am J Reprod Immunol; 72: 85–88.
14. De Araujo D, Yamakami L and Aikawa N, et al., (2014): Ovarian reserve in adult patients with childhood-onset lupus: A possible deleterious effect of methotrexate? Scand J Rheumatol; 43: 503–511.
15. La Marca A, Argento C, Sighinolfi G, et al., (2012): Possibilities and limits of ovarian reserve testing in ART. Curr Pharm, Biotechnol, 13, 398–408.
16. Velarde-Ochoa M, Esquivel-Valerio J, Vega-Morales D, et al. (2014): Anti-Mu¨llerian hormone in reproductive age women with systemic lupus erythematosus [article in English, Spanish]. Reumatol Clin; 11: 78–82.
17. Di Mario C, Petricca L, Rita M, et al., (2018): Anti-Müllerian hormone serum levels in systemic lupus erythematosus patients: Influence of the disease severity and therapy on the ovarian reserve.Endocrine,1-7.
18. Gasparin A, Souza L, Siebert M, et al., (2016): Assessment of antimullerian hormone levels in premenopausal patients with systemic lupus erythematosus. Lupus, 25(3):227-232.
19. Martins N, Seixas M, Pereira J, et al.. (2017): Anti-müllerian hormone and ovarian reserve in systemic lupus erythematosus. Clinical Rheumatology, 36(12), 2853–2854.
20. Sliem H, Tawfik G, Khalil K, et al. (2010): Pattern of systemic lupus erythematosus in Egyptian patients: the impact of disease activity on the quality of life. The Pan African medical journal, 6, 14.
21. Freeman E, Gracia C, Sammel M, et al. (2007): Association of anti-mullarian hormone levels with obesity in late reproductive-age women.Fertility and sterility,87 (1), 101-106.
22. Steiner A, Stanczyk F, Patel S, et al. (2010): Antimullerian hormone and obesity: Insights in oral contraceptive users. Contraception; 81: 245–248.
23. Yang J, Chen C, Chang W, et al. (2015): Pregnancy outcome of systemic lupus erythematosus in relation to lupus activity before and during pregnancy Journal of the Chinese Medical Association 78: 235-240.
24. Yuen S, Krizova A, Ouimet J, et al. (2009): Pregnancy Outcome in Systemic Lupus Erythematosus (SLE) is Improving: Results from a Case Control Study and Literature Review. The Open Rheumatology Journal, 2(1), 89–98.
25. Abdwani R, Al Shaqsi L, and Al-Zakwani I, (2018). Neonatal and Obstetrical Outcomes of Pregnancies in Systemic Lupus Erythematosus. Oman medical journal, 33(1), 15-21.
26. Smyth A, Oliveira G, Lahr B, et al. (2010).: A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 5: 2060–2068.