Is the immunological noise of abnormal autoimmunity an independent risk factor for premature ovarian aging?
OBJECTIVE
The risk for premature ovarian failure increases in association with two principal known etiologies: in the presence of excessive triple CGG expansions on the FMR1 (fragile X) gene (genetic etiology) and in association with a variety of autoimmune conditions (autoimmune etiology). To what degree milder forms of premature ovarian aging are also associated with these two etiologies is, however, unknown.


METHODS
We, therefore, investigated 119 consecutive, so identified, infertile women and statistically correlated by linear and logistic regression analyses ovarian function parameters to markers of a possible genetic etiology (number of CGG triple repeats on the FMR1 gene) and to markers of possible abnormal immune function (immune panel).


RESULTS
Sixty (50.4%) of 119 participants demonstrated at least one immune abnormality. Both groups did not differ statistically in age, mean follicle-stimulating hormone, estradiol, and antimüllerian hormone levels, although antimüllerian hormone suggested a trend toward higher levels in autoimmune participants (P = 0.19). Autoimmune participants also demonstrated lower mean triple CGG expansion sizes (P < 0.05) and included fewer women with greater than or equal to 35 triple repeats (relative risk, 4.0; 95% CI, 1.3-11.9; P < 0.01), previously reported to demarcate increased risk for premature ovarian aging.


CONCLUSIONS
Even minimal evidence of abnormal autoimmune function ("immunological noise") seems to increase risk toward premature ovarian aging, often manifesting as infertility. Evidence of abnormal autoimmune function, such as increased CGG triple expansion sizes, in young women, therefore, warrants vigilance for development of prematurely diminished ovarian reserve and infertility.
Gleicher
Norbert
N
Center for Human Reproduction-New York and the Foundation for Reproductive Medicine, New York, NY, USA. ngleicher@thechr.com
Weghofer
Andrea
A
Oktay
Kutluk
K
Barad
David H
DH
D000328:Adult; D000483:Alleles; D015551:Autoimmunity / Q000276:immunology*; D004958:Estradiol / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D051860:Fragile X Messenger Ribonucleoprotein 1 / Q000235:genetics; D006801:Humans; D007247:Infertility, Female / Q000235:genetics / Q000276:immunology; D016014:Linear Models; D016015:Logistic Models; D016649:Primary Ovarian Insufficiency / Q000235:genetics / Q000276:immunology*; D012307:Risk Factors; D019680:Trinucleotide Repeat Expansion / Q000235:genetics
D004958:Estradiol; D005640:Follicle Stimulating Hormone; D051860:Fragile X Messenger Ribonucleoprotein 1; C497683:FMR1 protein, human