Page 86 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 6
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ABSTRACT
Background: Subfertility, a time to pregnancy (TTP) longer than 12 months, is present in 40% of female rheumatoid arthritis (RA) patients who are actively trying to conceive. Since RA patients appear to reach menopause at a younger age, a lower ovarian reserve may explain the reduced fertility. Serum anti-Müllerian hormone (AMH) levels are the best proxy to measure ovarian reserve. Our objectives were to study AMH levels in female RA patients and determine the association of preconceptional serum AMH levels with TTP.
Methods: a post-hoc analysis was performed within patients of the Pregnancy-induced Amelioration of RA (PARA) cohort, who were assessed preconceptionally. Serum AMH levels were measured with the Ansh Labs pico AMH ELISA assay, and compared to an existing cohort of healthy controls.
Results: preconceptional serum was available in 209 women of the PARA cohort (aged 32.1±3.9 years), of whom 45% were subfertile in the current episode. The median AMH level was 2.5 ug/L (IQR 1.5–4.6). AMH levels were signi cantly lower compared to healthy controls (p<0.001), with 17% of patients having levels below the age-speci c 10th percentile. Multivariable analysis showed a negative association of AMH with the presence of anti-citrullinated protein antibodies (ACPA) (p=0.009). AMH levels showed no signi cant association with TTP (p=0.26).
Conclusion: women with RA have lower AMH levels than healthy controls, and AMH levels were lower in ACPA positive patients. However, since preconceptionalAMHlevelswerenotassociatedwithTTP,thereducedAMH levels do not explain the reduced fertility in RA patients.