This study aims to assess ovarian reserve markers in Behçet's disease (BD) patients. Ten BD and 22 healthy controls were evaluated for ovarian reserve by examining the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, inhibin B, total morning testosterone, prolactin, thyroid-stimulating hormone (TSH), and antral follicle count. Anti-Müllerian hormone (AMH) was measured using two different enzyme-linked immunosorbent assay (ELISA) kits. Demographic data, menstrual abnormalities, disease parameters, and treatments were also analyzed. The median current age was similar in BD patients and controls (34 (20-40) vs. 31.3 (20-42) years, p = 0.33). A positive correlation was observed between the AMH Gen II ELISA and AMH/MISAnshLabs ELISA assays in the BD patients (r = +0.98; p < 0.0001) and healthy controls (r = +0.93; p < 0.0001). The mean AMH by Gen II (0.93 ± 0.8 vs. 2.59 ± 1.8 ng/mL, p = 0.01) and AMH/MIS AnshLabs ELISA (1.07 ± 0.86 vs. 2.51 ± 1.8 ng/mL, p = 0.02) were significantly reduced in the BD patients versus controls. A trend of decreased AMH (<1.0 ng/mL) was observed in BD patients compared to that in the controls (50 vs. 19 %, p = 0.09) using either kits. The mean FSH was significantly higher in the BD patients compared to that in the controls (9.1 ± 3.6 vs. 6.5 ± 2.7, p = 0.04). No differences were found for the other ovarian parameters in both groups (p > 0.05). Current disease activity was only observed in BD patients with a low AMH level; however, there was no statistical significance (40 vs. 0 %, p = 0.44). Cyclophosphamide use was reported in only one patient with a low AMH and high FSH level. The present study was the first to suggest that BD patients may have diminished ovarian reserve. The contribution of disease activity remains to be determined.

To the best of our knowledge, our present study was the first to suggest that patients with TA may have diminished ovarian reserve.

Background Takayasu arteritis (TA) is a rare idiopathic systemic chronic vasculitis that involves large arteries. This disease occurs mainly in female gender during the reproductive age and ovarian reserve and future fertility are major topic of interest. Aging, surgery and hypothalamic-pituitary-gonad axis dysfunction have been found to influence the quantity and quality of primordial follicles in ovaries and, ultimately, the ovarian reserve. Other conditions such as autoimmune oophoritis and immunosuppressive drugs, particularly cyclophosphamide, may also result in diminished ovarian reserve. Female TA patients are susceptible to these factors but there is no systematic study assessing this ovary abnormality in these patients. Objectives To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in TA patients. Methods We have screened 52 consecutive female patients with TA. All patients aged between 18 and 45 years and fulfilled the American College of Rheumatology classification criteria. Exclusion criteria were: current pregnancy, hypothalamus-pituitary-gonadal axis dysfunction, use of hormonal contraceptive in the last six months, gynecological surgery, gynecological cancer, presence of an additional autoimmune disease, did not agree to participate in this study and incomplete gonadal evaluation. Thirty-two were excluded: use of hormonal contraceptive (n=15), did not agree to participate (n=7), incomplete assessment (n=4), presence of granulomatosis with polyangiitis (n=2), current pregnancy (n=2), hyperprolactinemia (n=1) and current treatment for gynecological cancer (n=1). Therefore, a cross sectional study was conducted in 20 patients with TA and 24 healthy controls according to the same exclusion criteria. Anti-CoL (immunoblot) and ovarian reserve were assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), and antral follicle count (AFC). Demographical data, menstrual abnormalities, disease parameters and treatment were also analyzed. Results The median current age was similar in TA patients and controls (31.2±6.1 vs. 30.4±6.9 years, p=0.69). The frequency of decreased levels of AMH (50% vs. 17%, p=0.02) and the median of AMH (0.7 vs. 2.7ng/mL, p=0.008) were significantly reduced in TA patients compared to controls without significant menstrual abnormalities with regard to the median of flow duration (p=0.25) and cycle length (p=0.85). The other hormones and AFC were similar to controls (p>0.05). Anti-CoL was solely observed in TA patients (5% vs. 0%, p=0.45). Further evaluation of TA patients with low AMH levels (<1.0 ng/mL) versus normal AMH levels (>1.0 ng/mL) revealed that the frequency of disease activity (p=1.0) and the median of ESR (p=0.6), CRP (p=0.4), prednisone cumulative dose (p=0.8) and methotrexate cumulative dose (p=0.8) were comparable in both groups. Cyclophosphamide use was reported in only one patient with reduced ovarian reserve, whereas none of the remaining patients received gonadotoxic drug. ...