Page 105 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

INTRODUCTION
The ovarian function depends on both the quantity as well as the quality of the primordial follicles in the ovaries. At birth, there are approximately 1,000,000 primordial follicles present in the ovaries. This number gradually decreases over time, resulting in about 300,000 remaining follicles at menarche.1,2 During her twenties and thirties, a woman’s follicle pool further decreases, with a slight acceleration in her late thirties and early forties. Finally, the near depletion of the ovarian follicle pool is marked by the cessation of menstruation.3 The last menstrual period in a woman’s life span, i.e. the menopause, occurs at a mean age of 51 years. Infertility generally sets in approximately 10 years before a woman experiences menopause.3 This results not only from the decline in number of developing ovarian follicles over time, but also from a decrease in quality of the oocytes maturing within these follicles due to accumulated damage from birth onwards.4
The age at which a woman reaches menopause, as well as the preceding period of
decreased fertility and infertility, varies greatly between women.3 At present, the
serum level of anti-Müllerian hormone (AMH) is the most reliable predictor for the
age at which a woman will enter menopause.5 Although, prediction of the actual
age at menopause based on a single AMH measurement is still not very precise.5
AMH is a member of the transforming growth factor β family and is produced in the
ovary by granulosa cells of early developing follicles.6 In both healthy and subfertile
women, there is a strong correlation between serum AMH levels and the number of 7 developing follicles in the ovaries. It has been shown that serum AMH levels become
undetectable approximately 5 years before a woman reaches menopause.7
Genes associated with the age of menopause, and more speci cally the length of the reproductive life span of a woman, are generally involved in DNA repair and maintenance as well as in the immune system.8 In this way, genes involved in healthy ageing are also predictors for ovarian function. Indeed, a compromised ovarian function has been described in patients with type II diabetes mellitus9 and in young girls with cancer.10 This suggests that an unhealthy soma results in an early decline of ovarian function. It is unknown whether the same holds true for chronic inflammation.8
AMH in RA – longitudinal
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