Preliminary study on the changes of ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age

Gao, Haokao; Ma, Jiaojiao; Wang, X; Lv, Tingting; Liu, J; Yanshun, Ren; Li, Y; Zhang, Y

doi:10.1177/0961203317726378

Cited by 22 publications

(18 citation statements)

References 33 publications

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“…Previous reports showed that serum AMH levels were lower in SLE patients ( 33 , 35 , 37 ). However, other studies reported that patients with SLE do not display significant alterations in the OR ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 84%

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Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

Morales-Martínez¹,

Salas-Castro²,

García-Garza³

et al. 2021

JFRH

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Objective: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder where the disease activity itself and the medications used for its treatment, may have adverse effects on ovarian function. This study aimed to assess the ovarian reserve (OR) in SLE patients. Materials and methods: The anti-müllerian hormone (AMH) and the antral follicle count (AFC), two markers to evaluate the OR was assessed in 64 SLE patients and compared to normal individuals. Additionally, we assessed whether the disease per se or the pharmacological treatments affect the OR. Results: Patients with SLE displayed alterations in the OR regardless of the presence of alterations of the menstrual cycle. The AFC and AMH were significantly lower in SLE patients with and without menstrual alterations when compared to control individuals (p<0.0001). However, the AFC and AMH levels were significantly correlated (p=0.006) in the SLE patients with menstrual alterations. Except for hydroxychloroquine that was statistically higher in SLE patients with menstrual alterations (p=0.04), the cumulative dose for cyclophosphamide, corticosteroid, and methotrexate was similar in SLE patients regardless of the occurrence of menstrual alterations. Conclusion: The monitoring of AMH and AFC in SLE patients should be used to detect the rapid and irreversible decline of the OR to provide a possibility of pregnancy to the SLE patients.

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Section: Discussionmentioning

confidence: 84%

“…Usually, the low AMH levels in SLE patients have been dichotomized for the presence of menstrual alterations, finding that the patients with abnormal menstruation had lower AMH levels than those of SLE patients without menstrual alterations ( 35 ). However, this has not been observed consistently ( 37 , 42 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

Morales-Martínez¹,

Salas-Castro²,

García-Garza³

et al. 2021

JFRH

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“…Therefore, AMH has been considered as a reliable biomarker of ovarian function. According to our previous study and other studies, AMH was significantly decreased in SLE patients 14,15 …”

Section: Introductionmentioning

confidence: 55%

Ghrelin is associated with anti‐mullerian hormone levels in Chinese systemic lupus erythematosus

Liu

et al. 2022

American J Rep Immunol

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Problem: Ghrelin has been thought of as a potential link between energy homeostasis and fertility. The aim of this study was to evaluate levels of ghrelin in obese and nonobese systemic lupus erythematosus (SLE) patients, and to reveal a possible association between ghrelin and Anti-Mullerian hormone (AMH) in SLE patients. Method of Study:One hundred SLE patients (50 obese and 50 non-obese subjects) at childbearing age and 100 age-matched healthy controls (50 obese and 50 non-obese subjects) were included. Ghrelin and leptin were examined by enzymelinked immunosorbent assay. AMH was tested through electrochemiluminescence.Demographics, clinical and laboratory indicators were obtained from medical records.Results: Ghrelin levels were significantly lower in obese SLE patients than non-obese SLE patients (P = .000) and obese controls (P = .002). Non-obese SLE patients and nonobese controls had similar ghrelin levels. Ghrelin levels were correlated positively with AMH (r = .2683, P = .0070) in SLE patients. And ghrelin were negatively associated with leptin (r = -.1969, P = .0496) and BMI (r = -.2401, P = .0161). Conclusion:Our results provide evidence for a potential relationship between ghrelin and AMH in SLE patients, indicating that ghrelin may play a part in energy homeostasis and ovarian damage of SLE patients.

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“…Decrease in the ovarian reserves is independently associated with presence of autoimmune disease, with low Anti-Mullerian hormone levels noted especially in SLE 3,[19][20][21] however; the impact on fertility may be compounded with use of alkylating agents, especially cyclophosphamide. The effect of cyclophosphamide on fertility is impacted by the age of patient at the time of exposure to the medication and dose of cyclophosphamide.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy in patients with systemic lupus erythematosus after cyclophosphamide therapy

Sen

Kurl

Khosroshahi

2021

Lupus

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Systemic lupus erythematosus (SLE) often affects females of reproductive age and Cyclophosphamide, an alkylating agent leading to premature ovarian insufficiency (POF) and labelled category D for pregnancy is used as induction therapy for severe manifestations of lupus. There have been multiple case series reflecting variable outcomes of pregnancies after cyclophosphamide use for cancers and autoimmune diseases. With increasing maternal age, we have an increasing population of lupus patients who may wish to conceive after having received cyclophosphamide therapy. The objective of our study was to improve our understanding of the impact of cyclophosphamide exposure on fertility and pregnancy outcomes in patients with SLE. We retrospectively reviewed the charts of all patients who had received intravenous cyclophosphamide at our academic institute in the time period from 2000–2018 and identified 440 patients which included 157 female patients of reproductive age. There were 37 documented pregnancies after the cyclophosphamide infusion, of which 23 patients had successful outcomes; 4 elective abortion and 10 miscarriages. There were 17 patients who developed POF, of which 7 also had end stage renal disease. The average cumulative dose of cyclophosphamide in the patients who had successful pregnancy was 4080.37 mg compared to 2806.25 mg in those who had a miscarriage (p 0.164) and 5526.47 mg in those who developed POF (p 0.046). Using multiple regressions to evaluate risk factors impacting pregnancy outcomes, when taken as a set, the predictors including race, serological profile, exposure to steroids and Mycophenolate mofetil, age at cyclophosphamide infusion, age at pregnancy, and cumulative cyclophosphamide dose accounted for 46.29% of the variance in outcome of pregnancy (p 0.23) and 39.58% of the variance in development of premature ovarian failure (p 0.008). We noted statistical significance in the impact of maternal age at time of pregnancy (p 0.04) and duration of time between the last infusions to subsequent pregnancy (p 0.02) to pregnancy outcome. Our findings suggest that a longer time interval between the last cyclophosphamide infusion and subsequent pregnancy was favorable for a successful outcome and higher cumulative cyclophosphamide dose is more likely to be associated with premature ovarian failure.

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Preliminary study on the changes of ovarian reserve, menstruation, and lymphocyte subpopulation in systemic lupus erythematosus (SLE) patients of childbearing age

Cited by 22 publications

References 33 publications

Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

Ghrelin is associated with anti‐mullerian hormone levels in Chinese systemic lupus erythematosus

Pregnancy in patients with systemic lupus erythematosus after cyclophosphamide therapy

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