Anti-Mullerian hormone serum levels in systemic lupus erythematosus patients: Influence of the disease severity and therapy on the ovarian reserve

PurposeSystemic lupus erythematosus (SLE) mainly affects childbearing age women and pharmacological treatments may negatively influence the ovarian reserve. Anti-Mullerian hormone (AMH) could be a good biomarker for ovarian reserve.MethodsAMH serum levels were assessed in 86 consecutive SLE female patients with regular menstrual cycle compared with 44 aged matched healthy controls. Clinical and demographic characteristics, disease duration, pattern of organ involvement, and previous and current therapies were recorded.ResultsAMH levels were comparable between patients and controls (4.23.1ng/ml vs. 5.0 +/- 3.1ng/ml, p=0.21). According to disease severity, AMH levels were lower in SLE patients with major organ involvement than in controls (3.8 +/- 2.7ng/ml vs. 5.0 +/- 3.1ng/ml, p=0.08); no difference was found between SLE patients with mild organ involvement (4.5 +/- 3.4ng/ml) and controls (p=0.43). Grouping patients based on the pharmacological treatments, AMH serum levels did not differ among SLE patients treated with antimalarials only (4.7 +/- 3.3ng/ml), conventional disease-modifying antirheumatic drugs (cDMARDs) only (4.8 +/- 3.2ng/ml), cDMARDs and antimalarials (3.9 +/- 2.9ng/ml) or cyclophosphamide (CYC) only (4.9 +/- 3.9ng/ml), compared to controls, but patients sequentially treated with cDMARDs and CYC, had significantly lower AMH serum levels than controls (p=0.01).Conclusions SLE patients showed comparable AMH levels than controls, however, a reduction of the ovarian reserve was associated with sequentially therapy with CYC and cDMARDs and with the disease severity. AMH could be a sensitive and specific biomarker of ovarian reserve in SLE and it could be useful for therapeutic strategy and family planning.