Background Takayasu arteritis (TA) is a rare idiopathic systemic chronic vasculitis that involves large arteries. This disease occurs mainly in female gender during the reproductive age and ovarian reserve and future fertility are major topic of interest. Aging, surgery and hypothalamic-pituitary-gonad axis dysfunction have been found to influence the quantity and quality of primordial follicles in ovaries and, ultimately, the ovarian reserve. Other conditions such as autoimmune oophoritis and immunosuppressive drugs, particularly cyclophosphamide, may also result in diminished ovarian reserve. Female TA patients are susceptible to these factors but there is no systematic study assessing this ovary abnormality in these patients.
Objectives To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in TA patients.
Methods We have screened 52 consecutive female patients with TA. All patients aged between 18 and 45 years and fulfilled the American College of Rheumatology classification criteria. Exclusion criteria were: current pregnancy, hypothalamus-pituitary-gonadal axis dysfunction, use of hormonal contraceptive in the last six months, gynecological surgery, gynecological cancer, presence of an additional autoimmune disease, did not agree to participate in this study and incomplete gonadal evaluation. Thirty-two were excluded: use of hormonal contraceptive (n=15), did not agree to participate (n=7), incomplete assessment (n=4), presence of granulomatosis with polyangiitis (n=2), current pregnancy (n=2), hyperprolactinemia (n=1) and current treatment for gynecological cancer (n=1). Therefore, a cross sectional study was conducted in 20 patients with TA and 24 healthy controls according to the same exclusion criteria. Anti-CoL (immunoblot) and ovarian reserve were assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), and antral follicle count (AFC). Demographical data, menstrual abnormalities, disease parameters and treatment were also analyzed.
Results The median current age was similar in TA patients and controls (31.2±6.1 vs. 30.4±6.9 years, p=0.69). The frequency of decreased levels of AMH (50% vs. 17%, p=0.02) and the median of AMH (0.7 vs. 2.7ng/mL, p=0.008) were significantly reduced in TA patients compared to controls without significant menstrual abnormalities with regard to the median of flow duration (p=0.25) and cycle length (p=0.85). The other hormones and AFC were similar to controls (p>0.05). Anti-CoL was solely observed in TA patients (5% vs. 0%, p=0.45). Further evaluation of TA patients with low AMH levels (<1.0 ng/mL) versus normal AMH levels (>1.0 ng/mL) revealed that the frequency of disease activity (p=1.0) and the median of ESR (p=0.6), CRP (p=0.4), prednisone cumulative dose (p=0.8) and methotrexate cumulative dose (p=0.8) were comparable in both groups. Cyclophosphamide use was reported in only one patient with reduced ovarian reserve, whereas none of the remaining patients received gonadotoxic drug.
Conclusions Therefore, the present study demonstrated for the first time a high prevalence of diminished ovarian reserve in TA patients reinforcing fertility counseling.
Disclosure of Interest None declared
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