Assessment of ovarian reserve by serum anti-Müllerian hormone in patients with systemic lupus erythematosus: a meta-analysis

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune and cyclophosphamide (CYC) is often used in the therapy of SLE. Anti-Müllerian hormone (AMH) is expressed in the ovarian granulosa cells and is a reliable biomarker for ovarian reserve. Recent studies have showed that SLE patients have lower serum AMH levels and CYC has a negative influence on ovarian reserve. But the results are conflicting in other studies. The objective of our study is to perform a systemic review and metaanalysis to confirm the relationship between SLE and ovarian reserve reflected by serum AMH levels as well as the effect of CYC on ovarian reserve of SLE patients. METHODS: PubMed, Embase, Web of Science, CNKI, CHINESE WANFANG, China Science and Technology Database (VIP) databases were searched for eligible studies by two independent authors. Studies comparing serum AMH levels between SLE patients and healthy controls as well as serum AMH levels between SLE patients with and without the treatment of CYC were extracted. All statistical analyses were performed with STATA 12.0. RESULTS: Totally 19 studies including 1,272 SLE patients and 555 healthy controls were included in our study. In a comparison of serum AMH levels between SLE patients and healthy controls, the pooled SMD was -0.79 (95% CI, -1.41 to -0.18) (P<0.05), indicating a significantly lower serum level of AMH in SLE patients. The results were repeated in subgroup analyses by region, diagnostic criteria of SLE and AMH detection methods. The therapy of CYC in SLE patients had a negative influence on serum AMH levels with the pooled SMD of -0.58 (95% CI, -0.87 to -0.30) (P<0.05). CONCLUSIONS: SLE is related to increased risk of decreased ovarian reserve and the treatment of CYC can do harm to ovarian reserve.