Evaluation of Ovarian Reserve Tests in Women with Systemic Lupus Erythematosus

Ulug, Pasa; Öner, Gökalp; Kasap, Burcu; Akbas, Emin Murat; Özçıçek, Fatih

doi:10.1111/aji.12249

Cited by 24 publications

(31 citation statements)

References 13 publications

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“…Subclinical affection of ovarian reserve tests were observed in patients of SLE. Serum FSH and/or LH were significantly higher in some studies [8,12] and significantly lower in others versus controls although they remain within reference value [13].…”

Section: Effect Of Sle On Ovarian Reservementioning

confidence: 68%

“…Lower median antral follicle count (AFC) was significantly observed by pelvic ultrasound scan in SLE patient when compared with the controls [9,12].…”

Section: Effect Of Sle On Ovarian Reservementioning

confidence: 99%

“…After correlation of all parameters of ovarian reserve tests to each other's, Ulug et al [12] found that age of the patient had strong positive association with FSH (r=0.83, p=0.039). Moreover, their multivariate analysis showed that AFC was the only significant predictor of menstrual irregularity (1.321, 95% CI 1.014-1.372; P=0.03) in SLE patients.…”

Section: Effect Of Sle On Ovarian Reservementioning

confidence: 99%

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Ovarian Functions and Reproductive Preservation in Patients with Systemic Lupus Erythematosus: A Review of Literature

Altraigey¹,

Talaat²

2016

JFIV Reprod Med Genet

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Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease of unknown etiology. The course of SLE is highly variable, with recurrent remission and exacerbation. The prevalence of the disease is affected by race, age and gender. In this review of literature, we tried to surf the web searching for all of articles concerned with ovarian functions, reserve and preservation among patients with SLE.

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Section: Effect Of Sle On Ovarian Reservementioning

confidence: 68%

“…Lower median antral follicle count (AFC) was significantly observed by pelvic ultrasound scan in SLE patient when compared with the controls [9,12].…”

Section: Effect Of Sle On Ovarian Reservementioning

confidence: 99%

Section: Effect Of Sle On Ovarian Reservementioning

confidence: 99%

See 1 more Smart Citation

Ovarian Functions and Reproductive Preservation in Patients with Systemic Lupus Erythematosus: A Review of Literature

Altraigey¹,

Talaat²

2016

JFIV Reprod Med Genet

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“…Effect of CYC on FSH, LH, and estradiol has been noted in few studies described previously [ 6 , 7 , 9 ]; however, studies on AMH and follicular counts are limited [ 16 , 21 – 24 ]. Effect of CYC on ovarian volumes in SLE has not been assessed prior to this study, although one study did find lower ovarian volumes in patients of SLE not previously exposed to CYC [ 22 ]. AMH levels were found to be lower in SLE patients previously exposed to CYC, but doses as per the Euro-Lupus regimen were not found to affect AMH levels [ 16 , 21 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Ovarian dysfunction with moderate-dose intravenous cyclophosphamide (modified NIH regimen) and mycophenolate mofetil in young adults with severe lupus: a prospective cohort study

et al. 2020

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Background Ovarian toxicity is a dreaded complication of cyclophosphamide (CYC). With the use of lower cumulative doses of intravenous CYC (modified NIH regimens) and availability of better markers of ovarian toxicity, the incidence of ovarian dysfunction needs reassessment. Lupus disease activity, by itself, is also believed to affect ovarian function negatively. Methods This single-centre prospective cohort study recruited 50 female patients of severe lupus aged 18–40 years. Twenty-five patients each received induction with either monthly intravenous CYC (0.5–0.75 g/m 2 ) for 6–9 months or daily oral mycophenolate mofetil (MMF). Details of menstrual irregularities; serum levels of FSH, LH, estradiol, AMH, and inhibin B; and sonographic assessment of ovarian volume and antral follicular count were done at baseline and 6 months after treatment. Amenorrhoeic patients were re-evaluated at 1 year. Results Mean (SD) age of subjects in the CYC and MMF groups was 31.4 (6.3) and 28.4 (4.4) years, respectively. Mean (SD) SLEDAI at the initiation of therapy was 7.2 (2.5) in the CYC group and 5.8 (3.4) in the MMF group. The mean cumulative dose of CYC used was 4.6 (1.8) g. Three patients in the CYC group (versus none in MMF) had amenorrhoea at 6 months—two of these regained menses within 6 months, while only one (4%) developed sustained amenorrhoea (lasting more than 12 months) at 41 years of age, likely menopause. Serum FSH levels increased ( p = 0.03), while AMH ( p = 0.002) and inhibin B ( p < 0.001) levels decreased significantly with 6 months of CYC therapy. Ovarian volume also reduced significantly ( p = 0.005) with 6 months of CYC therapy, while antral follicular count reduced numerically ( p = 0.32). Levels of AMH, inhibin-B, estradiol, ovarian volume, and antral follicular count after 6 months therapy were significantly lesser in the CYC group compared to the MMF group, despite being similar before the start of therapy. Conclusions Ovarian dysfunction with monthly intravenous CYC (modified NIH regimen) was predominantly subclinical, with a negative effect on ovarian reserve. No premature ovarian failure was noted at 1 year. No ovarian dysfunction occurred in the MMF group, despite having patients with severe background lupus. Use of intravenous CYC for induction may thus not be restricted in young lupus females with incomplete families for fear of gonadotoxicity, especially in life- or organ-threatening situations, where the benefits outweigh this subclinical risk.

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“…Autoimmune oophoritis may provide a possible explanation for these findings. 15 Elevated anticorpus luteum antibody levels have been associated with ovarian dysfunction in patients with lupus. 16 Additionally, patients with lupus often experience comorbid conditions, such as end-stage renal disease and autoimmune hypothyroidism, and are often on long-term medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids that may contribute to reduced fertility by impairing ovulation.…”

Section: Introductionmentioning

confidence: 99%

Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study

et al. 2016

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ObjectiveSystemic lupus erythematosus (SLE) disproportionately affects women and often develops during their reproductive years. Research suggests that some women who receive cyclophosphamide as treatment for SLE experience earlier decline in menstrual function, but reproductive health among women with SLE who have not taken this drug is less well understood. This study aims to better understand the relation between SLE and reproduction by assessing early secondary amenorrhoea and pregnancy in women treated with and without cyclophosphamide from a population-based cohort with large numbers of African-Americans.MethodsFemale patients with SLE, ages 20–40 at time of diagnosis, who were 40 years or older at the time of the survey were included in this analysis (N=147). Participants in the Georgians Organized Against Lupus (GOAL) study were asked about their reproductive histories including early secondary amenorrhoea, defined as loss of menstruation before age 40.ResultsWomen who were cyclophosphamide naïve had an increased prevalence of early secondary amenorrhoea compared with population estimates, 13–17% compared with 1–5%. Factors associated with early secondary amenorrhoea in women not treated with cyclophosphamide were marital status and receipt of a kidney transplant. Treatment with cyclophosphamide doubled the prevalence after adjustment for patient characteristics. Over 88% of women reported being pregnant at least once, and about 83% of these had a child, but the majority of pregnancies occurred before diagnosis.ConclusionsSLE diagnosed in early adulthood may affect women's reproductive health even if they are not treated with cyclophosphamide. Better understanding of other factors related to reproductive health in this population will improve clinicians' and patients' abilities to make treatment and family planning decisions.

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Evaluation of Ovarian Reserve Tests in Women with Systemic Lupus Erythematosus

Abstract: In this preliminary study, the first in SLE patients, we illustrated that women with SLE had lower ovarian reserves and higher menstrual irregularity compared with healthy controls according to hormonal and ultrasonographical evaluation.

Cited by 24 publications

References 13 publications

Ovarian Functions and Reproductive Preservation in Patients with Systemic Lupus Erythematosus: A Review of Literature

Ovarian Functions and Reproductive Preservation in Patients with Systemic Lupus Erythematosus: A Review of Literature

Ovarian dysfunction with moderate-dose intravenous cyclophosphamide (modified NIH regimen) and mycophenolate mofetil in young adults with severe lupus: a prospective cohort study

Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study

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