title: Assessment of ovarian reserve and Doppler characteristics in patients with multiple sclerosis using immunomodulating drugs.
abstract: OBJECTIVE
  There is limited data about fertility in multiple sclerosis (MS) patients using immunomodulating drugs and no data exists regarding the ovarian reserve of these patients. Therefore, we aimed to evaluate, the ovarian reserve and doppler characteristics of MS patients using immunomodulating drugs.
  
  
  METHODS
  MS patients using immunomodulating drugs (interferon (IFN) β and glatiramer acetate) and age-matched healthy controls were included in the study. Subjects were examined in the early follicular phase of the menstrual cycle with transvaginal ultrasound to evaluate ovarian volume, antral follicle count (AFC) and ovarian stromal artery Doppler. On the same day, blood was taken for determining serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) levels. A subgroup analysis was also carried out between MS patients using only IFN β and controls to compare the same parameters.
  
  
  RESULTS
  Mean ovarian volume and total AFC were lower in MS patients using immunomodulating drugs than in the controls. FSH and E2 levels did not show any differences between the groups, but LH levels were significantly higher in MS patients. All the Doppler parameters of the ovarian stromal artery were higher in MS patients but not significantly. In the subgroup analysis, the same significant differences were found for ovarian volume, AFC and LH levels. In addition, MS patients showed significantly higher mean pulsatility index measurement than the controls.
  
  
  CONCLUSIONS
  The findings of this study demonstrated diminished ovarian volume and follicular reserve in MS patients using immunomodulating drugs compared to age matched healthy controls. However, further studies are required to elucidate whether compromised ovarian reserve in MS patients is due to drugs or the disease itself.
authors.affiliation: Kırıkkale University School of Medicine, Department of Obstetrics and Gynecology, Kırıkkale, Turkey.
authors.forename: Aylin Pelin
authors.initials: AP
authors.lastname: Cil
authors.affiliation: Ufuk University School of Medicine, Department of Neurology, Ankara, Turkey.
authors.forename: Alev
authors.initials: A
authors.lastname: Leventoğlu
authors.affiliation: Ankara University School of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sönmezer
authors.affiliation: Kırıkkale University School of Medicine, Department of Neurology, Kırıkkale, Turkey.
authors.forename: Rabia
authors.initials: R
authors.lastname: Soylukoç
authors.affiliation: New York Medical College, Department of Obstetrics and Gynecology, Valhalla, Ny, and Institute For Fertility Preservation, Center For Human Reproduction, New York, Usa.
authors.forename: Kutluk
authors.initials: K
authors.lastname: Oktay
keywords: Doppler; Multiple Sclerosis; immunomodulating therapy; interferon-beta; ovarian reserve