Anti-Müllerian hormone in African-American women with systemic lupus erythematosus

Abstract

ObjectiveWomen with SLE may experience ovarian insufficiency or dysfunction due to treatment or disease effects. Anti-Müllerian hormone (AMH), a marker of ovarian reserve, has been examined in small populations of women with SLE with conflicting results. To date, these studies have included very few African-American women, the racial/ethnic group at greatest risk of SLE.MethodsWe enrolled African-American women aged 22–40 years diagnosed with SLE after age 17 from the Atlanta Metropolitan area. Women without SLE from the same area were recruited from a marketing list for comparison. AMH was measured in serum using the Ansh Labs assay (Webster, Texas, USA). We considered AMH levels <1.0 ng/mL and AMH <25th percentile of comparison women as separate dichotomous outcomes. Log-binomial regression models estimating prevalence ratios were adjusted for age, body mass index and hormonal contraception use in the previous year.ResultsOur sample included 83 comparison women without SLE, 68 women with SLE and no history of cyclophosphamide (SLE/CYC−) and 11 women with SLE and a history of cyclophosphamide treatment (SLE/CYC+). SLE/CYC+ women had a greater prevalence of AMH <1.0 ng/mL compared with women without SLE (prevalence ratio (PR): 2.90, 95% CI: 1.29 to 6.51). SLE/CYC− women were also slightly more likely to have AMH <1.0 ng/mL (PR: 1.62, 95% CI: 0.93 to 2.82) than comparison women. Results were similar when considering AMH <25th percentile by age of comparison women.ConclusionsTreatment with CYC is associated with low AMH in African-American women with SLE. SLE itself may also be associated with reduced AMH, but to a lesser extent.

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“… 10 In a recent cross-sectional study, 68 African-American women with SLE never exposed to CYC were 1.5-times more likely to have AMH levels below the 25th percentile when compared with women without SLE, even when controlling for other relevant factors such as BMI and use of hormonal contraception (prevalence ratio 1.55, 95% CI 0.97 to 2.47). 39 …”

“…10 In a recent crosssectional study, 68 African-American women with SLE never exposed to CYC were 1.5-times more likely to have AMH levels below the 25th percentile when compared with women without SLE, even when controlling for other relevant factors such as BMI and use of hormonal contraception (prevalence ratio 1.55, 95% CI 0.97 to 2.47). 39 A prospective controlled study compared 20 non-CYCtreated patients with SLE with 20 age-matched healthy controls using transvaginal ultrasonographic measures of ovarian reserve. Patients with SLE had reduced OV and AFC and rates of higher menstrual irregularity.…”

Anti-Mullerian hormone in systemic lupus erythematosus

“…По данным М. Angley и соавт. [31], уровень АМГ у афроамериканок 22-40 лет с СКВ был в 1,5-1,6 раза ниже, чем у женщин без СКВ. Незначительное снижение сывороточного уровня гормона у женщин с СКВ, которые никогда не лечились циклоспорином, ассоциировалось с возрастом, ИМТ и использованием гормональной контрацепции.…”

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“… 12 13 Broaching the topic with open-ended questions about a woman’s future interest in pregnancy can begin a dialogue that is informative to both the woman (who may assume that her rheumatologist will not want her to conceive) and to the rheumatologist (who may assume that a woman with SLE may not want to have children). This study of AMH by Angley and colleagues 1 can further inform this discussion: for black women with SLE, whether they have received CYC or not, it is important to consider that their window for pregnancy may be more limited than for other women. While infertility may not be reduced overall, delaying conception too long may prevent them from having the family that they want.…”

“…This pilot study by Angley and colleagues, 1 published in this issue of Lupus Science & Medicine , demonstrates that black women with SLE, both without and especially with prior cyclophosphamide (CYC) therapy, have significantly lower levels of antimullerian hormone (AMH) than black women without SLE. AMH is steadily generated by existing ovarian follicles, which means that measuring its levels can provide a rough estimate of ovarian reserve, or the number of potential eggs a woman has left to produce.…”