Subclinical Impairment of Ovarian Reserve in Systemic Lupus Erythematosus Patients with Normal Menstruation Not Using Alkylating Therapy

Background: Disease activity is a major factor in menstrual disorders in systemic lupus erythematosus (SLE) patients not receiving alkylating therapy. However, the ovarian reserve of SLE women with normal menstruation is still unclear. Methods: Twenty-three SLE patients naive to cytotoxic agents (SLE group) and nineteen SLE patients receiving current or previous cyclophosphamide (CTX) therapy (without other cytotoxic agents; SLE-CTX group) were enrolled. Twenty-one age-matched healthy women served as controls. All patients and controls had a regular menstrual cycle. Basal hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E-2), and anti-Mullerian hormone (AMH), and antral follicle count (AFC) were analyzed in the two study groups and compared with the control group. Results: No significant differences were found between the SLE, SLE-CTX, and control groups in age, body mass index (BMI), and basal FSH and LH levels. The E-2 (P=0.023) levels were high and the AMH (P=0.000) values and AFC (P=0.001) were significantly lower in the SLE and SLE-CTX groups compared to control. However, these values were similar between the SLE and SLE-CTX groups. Conclusion: SLE patients not receiving alkylating therapy who had normal menstruation and short illness duration still had an impaired ovarian reserve.