We measured anti-Mullerian hormone (AMH), a marker of ovarian reserve, in women with lupus treated with cyclophosphamide (CYC) (Group I), CYC plus gonadotropin-releasing hormone agonist (GnRH-a) (Group II), or neither (Group III). We hypothesized that AMH would be diminished in women exposed to CYC vs women receiving adjunctive GnRH-a treatment or no CYC exposure.
48 pre-menopausal lupus patients were retrospectively divided into three treatment groups: CYC alone (Group I, n=11), CYC + GnRH-a (Group II, n=10), neither (Group III, n=27). Serum AMH levels between groups were compared using a non-parametric test (Wilcoxon rank-sum). Multiple linear regression adjusting for age was performed.
AMH (ng/mL) levels at the last collection were significantly lower in Group I vs Group III (mean ± SD: 0.18 ± 0.20 Group I vs 1.33 ± 1.59 Group III; p=0.015), and vs Group II (mean ± SD: 0.86 ± 1.06; p=0.018). When centered on age 30 years, average AMH levels for Group I, Group II, and Group III were: 0.20, 0.44, and 1.00, respectively. When adjusted for age, AMH between all groups was significantly different (p<0.0001).
Post-treatment AMH levels were significantly higher among patients receiving CYC + GnRH-a compared to CYC alone, suggesting that GnRH-a co-administration mitigates CYC-induced ovarian injury.