Page 116 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 7
management.30 The next generation of young female RA patients may therefore have a milder course of the disease, with better long-term outcomes. Whether ovarian function and reproductive performance will also bene t from these changes, should be addressed in future studies.
Fifty percent of the current participants used hormonal contraceptives during the follow-up assessment, mainly progesterone releasing intra-uterine devices, or the oral contraceptive pill (OCP). The effect of exogenous steroid hormones on serum AMH levels is still unclear, with several studies reporting no signi cant effect of exogenous hormones on serum AMH levels, whereas other studies have shown, although subtle, lower AMH levels in users of either OCPs or progesterone only pills.31,32 Sensitivity analyses excluding women using any of these hormones, still showed one-third of patients having AMH levels below the 10th percentile at follow-up. Therefore, the current use of contraceptives could not explain the decreased long-term serum AMH levels in our study group.
AMH levels in this study were measured with an ultrasensitive picoAMH assay. The comparison of AMH levels between patients and controls should be considered with caution, since the conversion factor applied to the controls has been developed in another laboratory than the laboratory that performed the measurements with the new assay. Inaccuracy due to the conversion, may give deviating results.25 Furthermore, the currently applied picoAMH assay has a lower limit of detection compared to the Gen II assay that was used for the AMH measurements in controls. Nevertheless, adjusting the very low values in the current patients to the LoD applied in the controls, still resulted in a signi cantly higher percentage of patients with AMH values below the 10th percentile of controls.
In conclusion, serum AMH levels show a faster decline over time in women with RA compared to healthy controls, supporting the idea that in chronic inflammatory conditions, the body is less t for reproduction. Optimal treatment of chronic inflammatory disease in an early phase may improve long-term women’s health.
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