title: Ovarian reserve in women with primary antiphospholipid syndrome.
abstract: OBJECTIVE
  The objective of this paper is to evaluate ovarian reserve in primary antiphospholipid syndrome (PAPS) women and the association between ovarian reserve tests and clinical and laboratorial parameters, and anti-corpus luteum antibody (anti-CoL).
  
  
  METHODS
  We screened 85 female patients between 18 to 40 years old with APS. Of these, 67 patients were excluded because of association with other autoimmune diseases (n = 42), contraindication or unwillingness to stop hormonal contraceptive (n = 21), current pregnancy or breastfeeding (n = 3) and previous ovarian surgery (n = 1). Therefore, a cross-sectional study was conducted in 18 PAPS patients and 24 healthy women. They were evaluated at early follicular phase with measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) and sonographic antral follicle count (AFC). Serum measurement of anti-CoL was determined by immunoblot analysis. All analyses were performed after at least six months from the last intake of hormonal contraceptive and resumption of menstruation.
  
  
  RESULTS
  The mean age was comparable in PAPS and controls (33.0 ± 5.0 vs. 30.4 ± 7.0 years; p = 0.19). Regarding ovarian reserve tests, the frequencies of low AFC (≤10) (56% vs. 22%, p = 0.04) and very low AFC (≤5) (37% vs. 9%, p = 0.04) were significantly higher in PAPS patients than controls. Trends of higher frequencies of reduced (<1.0 ng/ml), low (<0.5 ng/ml) and negligible (<0.2 ng/ml) AMH levels were found in PAPS patients (p = 0.08, p = 0.07 and p = 0.07, respectively). FSH, LH and estradiol were similar in patients and controls. There was no association between low ovarian reserve and specific types of antiphospholipid antibodies. Anti-CoL was solely observed in PAPS patients (11% vs. 0%; p = 0.177) and was not related to ovarian reserve tests.
  
  
  CONCLUSIONS
  Women suffering from PAPS possessed reduced ovarian reserve, with prevalence greater than 50%.
authors.affiliation: Department of Gynecology.
authors.forename: L Y S
authors.initials: LY
authors.lastname: Yamakami
authors.affiliation: Department of Gynecology.
authors.forename: P C
authors.initials: PC
authors.lastname: Serafini
authors.affiliation: Division of Rheumatology Department of Rheumatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
authors.forename: D B
authors.initials: DB
authors.lastname: de Araujo
authors.affiliation: Division of Rheumatology.
authors.forename: E
authors.initials: E
authors.lastname: Bonfá
authors.affiliation: Division of Rheumatology.
authors.forename: E P
authors.initials: EP
authors.lastname: Leon
authors.affiliation: Department of Gynecology.
authors.forename: E C
authors.initials: EC
authors.lastname: Baracat
authors.affiliation: Division of Rheumatology Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil clovis.silva@hc.fm.usp.br.
authors.forename: C A
authors.initials: CA
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D001323:Autoantibodies / Q000097:blood; D003338:Corpus Luteum / Q000276:immunology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D065851:Ovarian Reserve; D055815:Young Adult
chemical_list: D001323:Autoantibodies
keywords: Antiphospholipid syndrome; anti-Müllerian hormone; antral follicle count; autoimmune diseases; ovarian reserve test