Adjunctive GnRH-a treatment attenuates depletion of ovarian reserve associated with cyclophosphamide therapy in premenopausal SLE patients

Gynecol Endocrinol. 2012 Aug;28(8):624-7. doi: 10.3109/09513590.2011.650752. Epub 2012 Feb 2.

Abstract

Background: We measured antimullerian 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 versus women receiving adjunctive GnRH-a treatment or no CYC exposure.

Methods: Forty-eight premenopausal lupus patients were retrospectively divided into three treatment groups: CYC alone (group I, n = 11), CYC + GnRH-a (group II, n = 10) and neither (group III, n = 27). Serum AMH levels between groups were compared using a nonparametric test (Wilcoxon rank-sum). Multiple linear regression adjusting for age was performed.

Results: AMH (ng/mL) levels at the last collection were significantly lower in group I versus group III (mean ± SD: 0.18 ± 0.20 group I vs 1.33 ± 1.59 group III; p = 0.015), and versus 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).

Conclusion: Posttreatment AMH levels were significantly higher among patients receiving CYC + GnRH-a compared to CYC alone, suggesting that GnRH-a coadministration mitigates CYC-induced ovarian injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Mullerian Hormone / blood
  • Biomarkers / blood
  • Cohort Studies
  • Cyclophosphamide / adverse effects*
  • Cyclophosphamide / therapeutic use
  • Delayed-Action Preparations / therapeutic use
  • Female
  • Fertility Agents, Female / therapeutic use
  • Fertility Preservation*
  • Follow-Up Studies
  • Gonadotropin-Releasing Hormone / agonists*
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Immunosuppressive Agents / therapeutic use
  • Infertility, Female / chemically induced
  • Infertility, Female / prevention & control
  • Leuprolide / therapeutic use*
  • Lupus Erythematosus, Systemic / blood
  • Lupus Erythematosus, Systemic / drug therapy*
  • Lupus Erythematosus, Systemic / physiopathology
  • Ovary / drug effects*
  • Ovary / physiopathology
  • Premenopause
  • Protective Agents / therapeutic use*
  • Retrospective Studies

Substances

  • Biomarkers
  • Delayed-Action Preparations
  • Fertility Agents, Female
  • Immunosuppressive Agents
  • Protective Agents
  • Gonadotropin-Releasing Hormone
  • Anti-Mullerian Hormone
  • Cyclophosphamide
  • Leuprolide