Impact of Systemic Lupus Erythematosus on Ovarian Reserve in Premenopausal Women before Receiving Cyclophosphamide Therapy: Evaluation Using Anti-Mülleria

Introduction: Anti-Müllerian hormone (AMH) is shown to be a possible indicator of ovarian function. Severe systemic lupus erythematosus (SLE) patients exposed to high-dose cyclophosphamide .(CTX) have a much higher risk of developing infertility and premature ovarian failure. Therefore, .we performed a prospective case-control study to evaluate the impact of SLE on women’s ovarian .reserve using AMH before CTX therapy. Methods: SLE patients before receiving CTX therapy were .enrolled in our hospital. Age-matched healthy women were served as controls. Serum AMH level .was measured using an enzyme-linked immunosorbent assay. Basal hormone levels were measured including follicle-stimulating hormone, luteinizing hormone, and estradiol on the third day of .their menstrual periods. All participants underwent transvaginal ultrasonographic examination .for the determination of total antral follicle count on the third day. Results: AMH value in SLE patients was significantly lower compared to healthy control with normal ovarian reserve. No significant difference in AMH levels was found between SLE and healthy control with low ovarian reserve. Conclusions: SLE patients not receiving CTX therapy even with normal menstruation, still had an impaired ovarian reserve. Therefore, early monitoring of AMH levels could better reflect .the ovarian function and reproductive outcomes of SLE patients and relative protective strategy .needed to reserve fertility.

引言：抗苗勒管激素（AMH）被证明可能是卵巢功能的一个指标。接受大剂量环磷酰胺（CTX）治疗的重症系统性红斑狼疮（SLE）患者发生不孕和卵巢早衰的风险要高得多。因此，我们进行了一项前瞻性病例对照研究，在CTX治疗前使用AMH评估SLE对女性卵巢储备的影响。方法：在我院招募接受CTX治疗前的SLE患者。选取年龄匹配的健康女性作为对照。采用酶联免疫吸附测定法测量血清AMH水平。在月经周期第3天测量基础激素水平，包括卵泡刺激素、黄体生成素和雌二醇。所有参与者在第3天均接受经阴道超声检查以确定窦卵泡总数。结果：与卵巢储备正常的健康对照相比，SLE患者的AMH值显著降低。在卵巢储备较低的SLE患者和健康对照之间，AMH水平无显著差异。结论：未接受CTX治疗的SLE患者即使月经正常，其卵巢储备仍受损。因此，早期监测AMH水平能够更好地反映SLE患者的卵巢功能和生殖结局，并且需要采取相关保护策略来保留生育能力。