LONGITUDINAL FOLLOW UP OF PATIENTS DIAGNOSED WITH COVID-19 DEMONSTRATES NO DECREASE IN OVARIAN RESERVE AS DEMONSTRATED BY SERUM ANTI-MÜLLERIAN HORMONE (AMH) AT 3 AND 6 MONTHS: A PILOT STUDY

Abstract

To assess the impact of COVID-19 infection on ovarian reserve as measured by serum AMH in reproductive age females at 3 and 6 months post diagnosis of COVID-19 infection. An institutional COVID-19 biorepository was used to identify female patients between the age of 18 and 41 years with serum samples collected at time of COVID-19 diagnosis, 3 months post diagnosis, and/or 6 months post diagnosis. After IRB approval, serum samples were analyzed for AMH level at each time point. A power analysis demonstrated a sample size of 22 unique participants provides 80% power to detect a 0.85 ng/mL difference in AMH level, with an alpha of 0.05. The paired Wilcoxon signed rank test was used to determine significant difference in serum AMH levels over two time points and the Friedman test was used to determine significant difference in serum AMH levels over three time points. P<0.05 was considered significant. 22 unique participants had serum samples over at least two separate time points, including either time of diagnosis (0-13 days post diagnosis), 3 months (84-111 days) post diagnosis, and/or 6 months (180-190 days) post diagnosis. Mean age was 32.67±7.0 years and mean BMI was 32.65±9.1 kg/m2. The majority of participants were Caucasian (68.2%) or African American (31.8%). One participant was Hispanic (4.55%) and the remainder were Non-Hispanic (95.45%). 50% of participants had received at least one dose of COVID-19 vaccine by the time of diagnosis, 45.45% were unvaccinated, and vaccination status was unknown for 1 participant. 4 of the participants (18.18%) were on oral contraceptive pills (OCPs) during at least one time point over which serum samples were obtained, and 45.45% had history of prior OCP use. Overall, there was no difference in paired serum AMH levels between baseline and the follow up values at 3 or 6 months (n=22, median difference -0.41 ng/mL, p=0.08). Median values at baseline and follow up were: 3.04 ng/mL [3.71] and 4.05 ng/mL [3.93]. Similarly, there were no differences in serum AMH when 3 and 6 month follow up was assessed separately: 3 months: n=17, median difference -0.69, p=0.08; 6 months: n=14, median difference -0.52, p=0.12. When AMH at three time points was assessed for patients with both 3 and 6 month samples (n = 10), no significant differences were noted (p=0.44). In this limited sample, there was a significant difference in baseline median AMH values between patients that were vaccinated compared to unvaccinated (2.0 ng/mL vs. 5.1 ng/mL); however, in a regression analysis controlling for age, race, and BMI, this difference was not significant (p=0.053). This study does not demonstrate an association between a COVID-19 diagnosis and a change in ovarian reserve as assessed by serum AMH at 3 and 6 months follow up. The findings are presented as a pilot study as the overall sample size was small, and additional data collection is ongoing.