Background/Purpose:  The onset of childhood systemic lupus erythematosus (cSLE) most frequently occurs after age 12. Studies in adolescents with cSLE suggest that ovarian dysfunction may be common, however little is known about mechanisms of ovarian dysfunction in these patients, the potential for permanent ovarian damage and the impact on future fertility. Anti-müllerian hormone (AMH) has been found to be useful in assessing ovarian reserve. Human oocytes peak in number during fetal life and decrease with age. Accordingly,, AMH levels decrease very slowly from puberty until menopause. AMH is has been demonstrated as a highly sensitive marker of diminished ovarian reserve in patients with cancer after chemotherapy. Only one study of ovarian reserve in adult women with SLE suggests lower levels of AMH compared to healthy controls. To our knowledge, examination of ovarian reserve and its clinical implications has not been studied in adolescent females with SLE.

Methods:  Data is being collected prospectively on an ongoing basis since October 2014. Female adolescents, 14 to 19 years old, with diagnosis of SLE by ACR criteria, oligoarticular and polyarticular JIA by ILAR criteria and healthy controls with gynecological age (chronological age minus age at menarche) ≥ 2 years, are eligible to participate. Pregnant patients, patients on any form of hormonal contraception and with a diagnosis of polycystic ovarian syndrome were excluded. The primary outcome is ovarian reserve, measured by AMH levels (AMH AssessR), for which normative data is available. Demographic and clinical data is collected, including: age, race, age of menarche, characteristics of menses, birth control behaviors, weight and BMI for all patients. Additionally,age of disease onset, disease activity measured by SLEDAI, disease damage measured by SLICC, current medications and prior exposure to cyclophosphamide is being collected for SLE patients.

Results:  To date, 16 subjects with SLE, 26 healthy controls and 6 subjects with diagnosis of JIA have been enrolled. Median age at enrollment was 17.4 years (IQR: 16.5, 19.4). Race and ethnicity were similar in the two groups; 22.5% of subjects were black, 57,1% Hispanic, 18.4% other/ mixed race, 2% white. Median age at menarche was 12 years. AMH levels were obtained in all participants. Median AMH was significantly lower in SLE (2.87 ng/ml, IQR: 2.12-3.70) vs health controls (4.80 ng/ml, IQR: 3.26-5.78), (p value = 0.04). Three out of 16 (19%) SLE subjects had AMH levels below normative values for healthy adolescents. Out of these 3 patients one had previously received cyclophosphamide and one had been pregnant 3 years prior to enrollment with a normal pregnancy and delivery.

Conclusion: Ovarian reserve, measured by AMH levels, appears to be affected in a small proportion of pediatric SLE patient compared to healthy controls. This information is important to keep in mind when educating and counseling patients on expectations regarding fertility.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-ovarian-reserve-and-function-in-adolescent-females-with-systemic-lupus-erythematosus/