Page 75 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

INTRODUCTION
Rheumatoid arthritis (RA) can already be manifest in women during their reproductive years and might therefore reduce the ability to have children. Female RA patients experience more fertility problems compared to healthy controls, resulting in a longer mean time to pregnancy.1-3 A reduced fertility seems to be present before diagnosis in female RA patients.1 Since, on average, women with RA appear to reach menopause at an earlier age compared to controls,1 the question is raised whether reduced fertility in women with RA is related to a compromised ovarian reserve.
In fertility clinics the ovarian reserve, which constitutes the number of primordial
follicles, is estimated using serum anti-Müllerian hormone (AMH) levels. AMH
is a member of the transforming growth factor (TGF)-β family and is produced
in the ovary by granulosa cells of early developing follicles.4 In both healthy and
subfertile women, there is a strong correlation between serum AMH levels and the
number of developing follicles in the ovaries, which declines with advancing age 5 until the follicle pool is nearly depleted and the woman enters menopause. Due to
this gradual decrease of quantity, which seems to go hand in hand with a decrease in quality of the oocytes harboured by the ovarian follicles, a woman will become infertile approximately ten years before she will enter menopause. The age at which a woman reaches menopause, as well as the preceding period of decreased fertility and infertility, varies greatly among women. At present, serum AMH is the most reliable predictor for the age at which a woman will enter menopause.5
Little is known about the effect of disease activity, parameters of inflammation or use of anti-rheumatic drugs on measurement of serum AMH levels.
Since RA patients who try to conceive use adjusted, and often less effective, medication, they frequently have increased disease activity. Thus far, no reports on the effect of RA disease activity on serum measurements of AMH are known. Preferably, women with RA who want to conceive should be screened for increased risk of subfertility before alteration or cessation of medication, so they can be referred to a gynecologist in due time and the time to pregnancy will be as short as possible. Since many of these patients use methotrexate (MTX), nowadays the rst choice drug in newly diagnosed RA, the effect of this potentially harmful drug on AMH levels should be studied.
The aim of this study therefore is to compare serum AMH concentrations between women with early RA and healthy controls, and to assess the influence of parameters of disease activity and the use of MTX on serum AMH levels in women with RA in childbearing age.
AMH in RA – early RA
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