Background and objectives: Systemic lupus erythematosus (SLE) predominantly affects women of reproductive age; however, the impact of the disease, chronic inflammation, and its treatments on ovarian reserve remains insufficiently characterized. This study aimed to assess the prevalence of diminished ovarian reserve in SLE and to evaluate the longitudinal associations of clinical characteristics, therapeutic exposures, and herpesvirus serologies with Anti- Müllerian Hormone (AMH) levels. Methods: This observational prospective monocentric study followed 80 premenopausal women (18–45 years) with SLE for 24 months. Clinical data, treatments, AMH levels, and herpesvirus serologies were collected every 6 months. Patients were stratified by diminished ovarian reserve (AMH <1 ng/mL). Longitudinal AMH trajectories and the impact of covariates were evaluated using repeated-measures analyses and linear mixed-effects models. Results: The cohort exhibited a high prevalence of diminished ovarian reserve (45% of the study population), associated with older age (37 ± 7 vs. 34 ± 7 years, p = 0.041), longer disease duration (14 ± 9 vs. 10 ± 6 years, p = 0.026), higher cumulative damage (p = 0.007), and lupus anticoagulant positivity (14% vs. 39%, p=0.009). Disease activity was comparable across groups. Hydroxychloroquine use was more frequent in women without diminished ovarian reserve (89% vs 69%, p = 0.033). Over 24 months, AMH levels remained stable with no progressive decline. Belimumab exposure did not adversely affect AMH trajectories, and viral serologies showed no direct long-term impact on AMH levels. Conclusions: This prospective longitudinal study highlights that diminished ovarian reserve is common in women with SLE. AMH levels remained stable over 24 months, with no adverse longitudinal association with belimumab exposure. Hydroxychloroquine use was associated with a lower prevalence of diminished ovarian reserve and warrants further investigation. Serial AMH assessment may support personalized reproductive counselling in women with SLE.
Diminished ovarian reserve in systemic lupus erythematosus: clinical, immunological, viral, and therapeutic determinants in a 24-month prospective study
Rizzo, MargheritaPrimo
;Beltrami, Silvia;Ruffilli, Francesca;Garaffoni, Carlo;Silvagni, Ettore;Bortolotti, Daria;Cianci, Giorgia;Maranini, Beatrice;Govoni, Marcello;Rizzo, Roberta;Bortoluzzi, Alessandra
Ultimo
2026
Abstract
Background and objectives: Systemic lupus erythematosus (SLE) predominantly affects women of reproductive age; however, the impact of the disease, chronic inflammation, and its treatments on ovarian reserve remains insufficiently characterized. This study aimed to assess the prevalence of diminished ovarian reserve in SLE and to evaluate the longitudinal associations of clinical characteristics, therapeutic exposures, and herpesvirus serologies with Anti- Müllerian Hormone (AMH) levels. Methods: This observational prospective monocentric study followed 80 premenopausal women (18–45 years) with SLE for 24 months. Clinical data, treatments, AMH levels, and herpesvirus serologies were collected every 6 months. Patients were stratified by diminished ovarian reserve (AMH <1 ng/mL). Longitudinal AMH trajectories and the impact of covariates were evaluated using repeated-measures analyses and linear mixed-effects models. Results: The cohort exhibited a high prevalence of diminished ovarian reserve (45% of the study population), associated with older age (37 ± 7 vs. 34 ± 7 years, p = 0.041), longer disease duration (14 ± 9 vs. 10 ± 6 years, p = 0.026), higher cumulative damage (p = 0.007), and lupus anticoagulant positivity (14% vs. 39%, p=0.009). Disease activity was comparable across groups. Hydroxychloroquine use was more frequent in women without diminished ovarian reserve (89% vs 69%, p = 0.033). Over 24 months, AMH levels remained stable with no progressive decline. Belimumab exposure did not adversely affect AMH trajectories, and viral serologies showed no direct long-term impact on AMH levels. Conclusions: This prospective longitudinal study highlights that diminished ovarian reserve is common in women with SLE. AMH levels remained stable over 24 months, with no adverse longitudinal association with belimumab exposure. Hydroxychloroquine use was associated with a lower prevalence of diminished ovarian reserve and warrants further investigation. Serial AMH assessment may support personalized reproductive counselling in women with SLE.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
