Background/Purpose: Polymyositis (PM) affects female gender during reproductive age. Ovarian reserve and future fertility are relevant, however there is no study performing a complete assessment of ovarian function in these patients.

Methods: From March 2011 to May 2014, 32 female PM patients (Bohan and Peter criteria, 1975), with age 18-40 years old, followed at the Outpatient Myopathy Clinic, Rheumatology Division of our tertiary center were screened. Twenty-four patients were excluded due to unwillingness to participate(n=8), hormonal contraceptive use(n=6), other autoimmune diseases(n=5), neoplasia(n=2), gynaecological surgery(n=2) and current pregnancy(n=1). Thus, a total of eight PM patients and 16 healthy volunteer age-matched women were enrolled in the study. All PM patients and healthy controls were evaluated at early follicular phase of menstrual cycle. Follicle stimulating hormone (FSH), estradiol, inhibin B and anti-Müllerian hormone (AMH) serum levels (ELISA) were determined. Transvaginal ultrasound was performed in all PM patients and controls by a blind sonographer using a 6.5 MHz endovaginal transducer. Ovarian volumes and antral follicle count (AFC) were also assessed.

Results: PM patients and controls had comparable mean age (31.4±6.5 vs. 30.7±6.2 years, P=0.946), ethnicity and socioeconomic class (P>0.05). PM mean age of onset was 27.3±6.5 years and disease duration of 6.5±4.1 years. Menstrual cycles were alike in both groups with a similar frequency of age at menarche, gynecological age, duration and length of menstrual cycle (P>0.05). The median serum level of AMH was significantly lower in PM compared to controls [0.7(0.3-3.4) vs. 3.1(1.4-4.0), P=0.021] and AMH levels ≤1ng/mL (50%vs. 6.3%, P=0.024) and very low AFC (37.5% vs. 6.3%, P=0.037) were more frequently observed in PM. The other ovarian reserve parameters (ovarian volume, FSH, inhibin B and estradiol levels) were similar in both groups (P>0.05). With regard to drugs, 6/8 (75%) were exposed to potentially gonodotoxic agents, one (12.5%) was treated with intravenous cyclophosphamide with a cumulative dose of 15g and five (62.5%) were treated with high cumulative methotrexate dose (>5g/m²).  Of these six exposed patients, 4 (67%) had low AMH levels and 3 (50%) had concomitant very low AFC.

Conclusion: The present study was the first to identify a subclinical ovarian dysfunction in PM patients during reproductive ages possible associated with a gonadotoxic effect of immunosuppressive drugs on ovarian follicular pool.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/subclinical-reduced-ovarian-reserve-in-adult-polymiositis-patients/