Background/Purpose: Aging, smoking, obesity and surgery have been found to influence the quantity and quality of primordial follicles in ovaries and, ultimately, the ovarian reserve. Other conditions such as autoimmune oophoritis, ovarian ischemia and hemorrhage may also result in diminished ovarian reserve. Female primary antiphospholipid syndrome (PAPS) patients are susceptible to these complications but there is no systematic study assessing this ovary abnormality. Methods: We screened 85 female patients between 18 to 40 years old with APS. Of these, 67 patients were excluded due to association with other autoimmune diseases (n=42), contraindication or unwillingness to stop hormonal contraceptive (n=21), current pregnancy or breastfeeding (n=3) and previous ovarian surgery (n=1). Therefore, a cross sectional study was conducted in 18 PAPS patients. Control group included 24 healthy volunteers recruited in primary care services according to the same inclusion and exclusion criteria. Complete ovarian function was assessed on the early follicular phase of the menstrual cycle, blinded to the other parameters of ovarian function. Ovarian reserve was assessed by: FSH, luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH) and antral follicle count (AFC) in patients without hormonal contraception for at least 12 consecutive months. Anti-corpus luteum antibody (anti-CoL) was detected by immunoblot technique. Results: Arterial thrombosis, venous thrombosis and pregnancy morbidity were observed in 17%, 83% and 33% of the PAPS patients, respectively. Lupus anticoagulant, anticardiolipin and anti-β2-GPI were detected in 67%, 83% and 11% of these patients. The mean of current age was similar between PAPS and controls (33.0 ± 5.0 vs. 30.4 ± 7.0 years old; p=0.189). Body mass index, smoking and the remaining demographic features were similar in both groups (p>0.05). Regarding ovarian reserve tests, the frequencies of low and very low AFC were significantly higher in PAPS patients compared to controls (56% vs. 22%, p=0.042; 37% vs. 9%, p=0.045, respectively). Trends to higher frequencies of reduced, low and negligible AMH levels were found in PAPS patients (p=0.08; p=0.07 and p=0.07; respectively). FSH, LH and estradiol were similar in PAPS patients and controls (p>0.05). Anti-CoL was solely observed in two PAPS patients (11% vs. 0%; p=0.177), one presented reduced ovarian reserve. Conclusion: The present report was the first to identify a high prevalence of diminished ovarian reserve in PAPS patients reinforcing the need of fertility counseling and family planning. Further study is necessary regarding the mechanisms by which PAPS causes ovarian impairment, as well as the most appropriate fertility treatment for these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ovarian-reserve-in-women-with-primary-antiphospholipid-syndrome/