AB0664 OVARIAN RESERVE IN SYSTEMIC SCLEROSIS

Abstract

BackgroundThe low prevalence of pregnancy in women with systemic sclerosis (SSc) is due to multi-factorial causes, including premature ovarian insufficiency (POI). Anti-Mullerian hormone (AMH) is one of the primary parameters for assessing reproductive function and ovarian reserve. The levels of AMH correlates with the residual follicular pool among women of reproductive age.ObjectivesTo assess AMH levels in SSc female patients of child-bearing potential, and analyze the relationship between AMH levels and disease severity, as well as the relationship between serum AMH levels and different therapeutic regimens.MethodsThe study group included 48 women with SSc aged 20-40 years, and the control group included 15 age-matched healthy women. Pts’ mean age was 32,9 [28;37] yrs, disease duration was 6,3 [3;10] yrs. Diffuse cutaneous subset of the disease had 41,7%, limited in 41,7% and overlap in 16,6% pts. AMH levels was measured using ELISA. AMH reference values ranged within 1.0-10.6 ng /ml. Values <1.0 were interpreted as a decreased ovarian reserve.ResultsMean AMH level was 2.8 ng/ml in SSc pts, and 3.1 ng/ml in the control group, showing no statistical difference. A decrease in ovarian reserve (AMH less than 1.0 ng/ml) was significantly more common in SSc pts compared to controls (45,8% vs. 13%, p<0,05).Table 1.AMH and forms of SScformdiffuse, n=20limited, n=20overlap, n= 8pMean AMH1,1 [0,06-1,5]*3,3 [0,4-5,6]*2,3 [0,7;3,4]* 0,03AMH >1 ng /ml, n (%)13 (65%)*7 (35%)*2 (25%)*0,05Mean AMH levels was significantly lower in the diffuse SSc in comparison with the limited SSc. A redaction of ovarian reserve (AMH less than 1.0 ng / ml) was more often observed in diffuse form of SSc compared to limited form (65% vs 35%), p=0.05.Table 2.AMH and course of SSccourseacute, n=5subacute, n=19chronic, n= 25pMean AMH1,2 [0,01-1,7]0,9 [0,05-1,3]3,5 [0,7;5,6]0,01AMH >1 ng /ml, n (%)3 (60%)13 (68,4%)*6 (24%)**0,03Mean AMH levels was significantly lower in acute and subacute course of SSc. A decrease of ovarian reserve was significantly more often observed in subacute course compared to chronic course of SSc (68% vs 24%, p=0,03).CYCCYC (+), n=14CYC (-), n=34pMean AMH0,8 [0,08-1,07]2,8 [0,4;3,6]0,01AMH >1 ng /ml, n9 (64,3)13 (32,2)nsMean AMH levels was significantly lower in pts with SSc receiving CYC. Correlation analysis revealed a negative correlation between AMH and cyclophosphamide (CYC) therapy (r=-0.33, p>0.05), with erythrocyte sedimentation rate (r=-0.36), heart damage (r=-0.32) and gastrointestinal involvement (r=-0.31), digital ulcers (r=-0.33) and digital pitting scars (r=-0.28). Correlation with other clinical manifestations, immunological markers and immunosuppressive therapy of SSc wasn’t found. In five patients who receivied CYC earlier, the levels of AMH was within normal values (the total dose of CYC did not exceed 4 g).ConclusionOvarian reserve was significantly more often reduced in women with SSc compared to healthy controls. Mean AMH levels was significantly lower in the diffuse SSc compared to the limited SSc. Reduction of ovarian reserve was more often observed in diffuse form SSc. Mean AMH level was significantly lower in acute and subacute course of SSc. A decrease of ovarian reserve was significantly more often observed in subacute course SSc compared to chronic course. The levels AMH negatively correlated with CYC therapy, erythrocyte sedimentation rate, heart and gastrointestinal tract involvement, digital ulcers and digital scars. CYC therapy negatively affected the ovarian function, and most likely in a dose-dependent manner.Disclosure of InterestsNone declared