Background The fertility potential of a woman has been defined with ovarian reserve (OR) which are of number of antral ovarian follicles and oocyte quality. It has been suggested that basal FSH levels are helpful to evaluate OR, but FSH has low accuracy in diagnosis of diminished OR (1). AMH is secreted by the granulose cells of early follicles, which is developing FSH independently, and is suggested to be an important marker of ovarian failure. The serum levels have been found to be proportional to the developing follicles and as well associated with the follicle pool (2). Among the all ovarian reserve tests, AMH is the most useful test to predict fertility potential (3).
Objectives To evaluate of ovarian reserves primary Sjögren's syndrome (pSS) and healthy subjects by AMH, antral follicle count (AFC), ovarian volume, and hormonal parameters.
Methods Twenty-four women with pSS and twenty-five healthy women as controls were enrolled to this study. The diagnosis of pSS was made by American-European consensus criteria. FSH, LH, E2, PRL, AMH levels were measured in follicular phase (days 2-6) of the menstrual cycle of using the AMH-ELISA. Concomitant pelvic ultrasonography was performed to total numbers of AFC.
Results The age, BMI, and obstetric history of patients with pSS and controls were comparable (p>0.05). The duration of menstrual cycle of the patients with pSS were significantly lower than that of the controls (p<0.05). The AMH of the patients pSS was significantly lower than that of the controls (p<0.05) (Figure 1). There were no significant differences among the patients with pSS and controls regard to the right and left ovarian volumes (p>0.05). The AFC of right and left ovaries in the patients with pSS were significantly lower than those of the controls (p<0.05). The LH of the patients with pSS was significantly higher than that of the controls (p<0.05); however, FSH, E2, and PRL levels of the study groups were found similar (p>0.05)
Conclusions Data from our study add support to the hypothesis that pSS women have a decline in ovarian reserve. pSS may present with findings of a decline in ovarian reserve leading to ovarian failure, including a decrease in AMH level and a decrease in AFC, before this is not enough to result in menstrual abnormalities such as oligomenorrhea or amenorrhea. Although this is not enough to result in premature ovarian failure.
Silva CA, Brunner HI. Gonadal functioning and preservation of reproductive fitness with juvenile systemic lupus erythematosus. Lupus. 2007; 16: 593–599.
Weenen C, Laven JS, VonBergh AR, Cranfield M, Groome NP, Visser JA, Kramer P, Fauser BC, Themmen AP. Anti-Müllerian hormone expression pattern in the human ovary: potential implications for initial and cyclic follicle recruitment. Mol Hum Reprod. 2004;10(2):77-83.
Gnoth C, Schuring AN, Friol K, Tigges J, Mallmann P, Godehardt E. Relevance of anti-Mullerian hormone measurement in a routine IVF program. Hum Reprod. 2008;23(6):1359- 65.
Disclosure of Interest None declared