Levels of Serum Anti–Müllerian Hormone, a Marker for Ovarian Reserve, in Women With Rheumatoid Arthritis

Abstract

Objective. Fertility is reduced in women with rheumatoid arthritis (RA), even before diagnosis. This may be due to a diminished ovarian reserve. The current study examined serum levels of anti-Mü llerian hormone (AMH), the most reliable endocrine marker for ovarian reserve, in early RA patients and the influence of disease activity and methotrexate (MTX) use on AMH concentrations. Methods. Serum AMH levels were measured in 72 women with recent-onset RA ages 18 -42 years and compared to 509 healthy women. The association between AMH and rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), erosions, C-reactive protein (CRP) level, disease activity (Disease Activity Score in 28 joints [DAS28]), and use of MTX was assessed. Results. At diagnosis, age-adjusted serum AMH levels did not differ significantly between patients and controls (P ‫؍‬ 0.254). AMH levels were not related to the presence of RF (P ‫؍‬ 0.487), anti-CCP (P ‫؍‬ 0.686), or erosions (P ‫؍‬ 0.350), and showed no significant correlation with CRP levels (r ‫؍‬ ؊0.207, P ‫؍‬ 0.083) or disease activity scores (DAS28; r ‫؍‬ 0.007, P ‫؍‬ 0.955). After 6 months of treatment, AMH levels in patients (n ‫؍‬ 53) were lower than at the time of diagnosis (P < 0.001), but did not differ from controls (P ‫؍‬ 0.741). There was no significant difference in AMH values after 6 months of treatment between patients who did (n ‫؍‬ 31) or did not (n ‫؍‬ 22) receive MTX (P ‫؍‬ 0.287). Conclusion. AMH levels in women with early RA are comparable to those of healthy controls, indicating that the reduced fertility in this patient group is not caused by diminished ovarian reserve. AMH levels are not affected either by disease activity or by short-term MTX use.

Fertility in women with rheumatoid arthritis: influence of disease activity and medication

“…This is in contrast to animal studies, where MTX has been shown to cause a reduction in the number of primordial follicles (ie, ovarian reserve) and a subsequent loss of ovarian function 33. We have previously shown that short-term MTX use in early RA does not affect ovarian reserve 34. As the women in the current study had been using MTX for several years, our results suggest that long-term use of MTX also does not have a negative effect on ovarian function and fertility.…”

Pregnancy and rheumatoid arthritis

“…However, in a prospective cohort study on RA and fertility, prior MTX treatment did not affect TTP [9]. Furthermore, short-term MTX treatment had no impact on the ovarian reserve in patients with RA [13]. Finally, it has been hypothesized that the impaired fertility in patients with RA is a result of a lower intercourse frequency [12].…”

“…To test this hypothesis, the levels of serum anti-Müllerian hormone (AMH) (the most reliable biomarker for ovarian reserve) were tested in 72 premenopausal women (age range 18e42 years) with early RA. No differences were observed between patients with RA and healthy controls, making it unlikely that the observed impaired fertility, already present at time of diagnosis, is related to a diminished ovarian reserve [13]. Personal choices, due to RA-related concerns, have been shown to be at least partially responsible for the smaller family size [8], but it cannot account for the observed impaired fertility.…”

A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus

“…For other DMARDs, the dosage of the Anti Müllerian Hormone (AMH) has been proposed in women taking medications to determine drug influence on fertility: no alterations have been described for methotrexate [156], mycophenolate mofetil, cyclosporine and tacrolimus [155].…”