Abstract
Multiple sclerosis (MS) is a chronic immune-mediated demyelinating disease of the central nervous system (CNS), which is more prevalent among women of childbearing age. Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disease of the CNS with similar prevalence features to MS and has recently been considered a different entity from MS. Measuring ovarian reserve is one way of evaluating fertility. Anti-Müllerian hormone (AMH) is a peptide hormone produced by ovarian granulosa cells of early follicles and is considered to be a marker for ovarian reserve. With MS and NMOSD predominance in young women, the present study aimed to address the possibility of these diseases affecting fertility by measuring AMH levels in MS and NMOSD patients and comparing it with healthy controls. The present study included 23 relapsing-remitting MS (RRMS) patients, 23 seronegative NMOSD patients, and 23 healthy age-matched controls between 18 and 45 years of age. Serum samples of the three groups were collected, and the AMH levels were measured with AMH Gen II Enzyme-Linked Immunosorbent Assay, Beckman Coulter kit. In the present study, the AMH levels did not differ significantly between the groups (p = 0.996). The mean AMH in the RRMS group was 3.59 ± 0.55 ng/ml compared with the mean of 3.60 ± 0.50 ng/ml in healthy controls. The mean AMH levels in the NMOSD group were 3.66 ± 0.61 ng/ml. Lower levels of AMH were found to be negatively associated with annualized relapse rate (in both groups of patients) and MS severity score. However, the difference was not significant. In NMOSD patients, the serum levels of AMH were negatively associated with disease duration (r = − 0.42, p = 0.023). There had been a significant negative correlation between mean AMH serum levels with Expanded Disability Status Scale (EDSS) at the time of diagnosis and at the time of study in the NMOSD group (r = − 0.402, p = 0.03 and r = − 0.457, p = 0.014, respectively). There was not a significant difference in mean serum AMH levels between RRMS and NMOSD patients compared with that of healthy controls. Further studies with larger sample sizes should be conducted, which take more variables affecting fertility in women with either RRMS or NMOSD into account to put an end to the controversial issue of fertility in this area.
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References
Abramsky O (1994) Pregnancy and multiple sclerosis. Ann Neurol 36:S38–S41. https://doi.org/10.1002/ana.410360712
Ajmera MR, Boscoe A, Mauskopf J, Candrilli SD, Levy M (2018) Evaluation of comorbidities and health care resource use among patients with highly active neuromyelitis optica. J Neurol Sci 384:96–103. https://doi.org/10.1016/j.jns.2017.11.022
Amato MP, Portaccio E (2015) Fertility, pregnancy and childbirth in patients with multiple sclerosis: impact of disease-modifying drugs. CNS Drugs 29:207–220
Anderson R, Nelson S, Wallace W (2012) Measuring anti-Müllerian hormone for the assessment of ovarian reserve: when and for whom is it indicated? Maturitas 71:28–33
Arora P, Polson DW (2011) Diagnosis and management of premature ovarian failure. Obstet Gynaecol 13:67–72
Borisow N, Döring A, Pfueller CF, Paul F, Dörr J, Hellwig K (2012) Expert recommendations to personalization of medical approaches in treatment of multiple sclerosis: an overview of family planning and pregnancy. EPMA J 3:9
Borisow N, Kleiter I, Gahlen A, Fischer K, Wernecke KD, Pache F, Ruprecht K, Havla J, Krumbholz M, Kümpfel T, Aktas O, Ringelstein M, Geis C, Kleinschnitz C, Berthele A, Hemmer B, Angstwurm K, Weissert R, Stellmann JP, Schuster S, Stangel M, Lauda F, Tumani H, Mayer C, Zeltner L, Ziemann U, Linker RA, Schwab M, Marziniak M, Then Bergh F, Hofstadt-van Oy U, Neuhaus O, Winkelmann A, Marouf W, Rückriem L, Faiss J, Wildemann B, Paul F, Jarius S, Trebst C, Hellwig K; NEMOS (Neuromyelitis Optica Study Group) (2017) Influence of female sex and fertile age on neuromyelitis optica spectrum disorders. Mult Scler 23:1092–1103. https://doi.org/10.1177/1352458516671203
Borisow N, Hellwig K, Paul F (2018) Neuromyelitis optica spectrum disorders and pregnancy: relapse-preventive measures and personalized treatment strategies. EPMA J 9:249–256
Calabresi PA (2004) Diagnosis and management of multiple sclerosis. Am Fam Physician 70:1935–1944
Cavalla P, Rovei V, Masera S, Vercellino M, Massobrio M, Mutani R, Revelli A (2006) Fertility in patients with multiple sclerosis: current knowledge and future perspectives. Neurol Sci 27:231–239
Chapman C, Cree L, Shelling AN (2015) The genetics of premature ovarian failure: current perspectives. Int J Women's Health 7:799
Cocco E et al (2008) Frequency and risk factors of mitoxantrone-induced amenorrhea in multiple sclerosis: the FEMIMS study. Mult Scler J 14:1225–1233
Dahl J, Myhr K-M, Daltveit A, Hoff J, Gilhus N (2005) Pregnancy, delivery, and birth outcome in women with multiple sclerosis. Neurology 65:1961–1963
Dewailly D, Andersen CY, Balen A, Broekmans F, Dilaver N, Fanchin R, Griesinger G, Kelsey TW, la Marca A, Lambalk C, Mason H, Nelson SM, Visser JA, Wallace WH, Anderson RA (2014) The physiology and clinical utility of anti-Müllerian hormone in women. Hum Reprod Update 20:370–385
Dwosh E, Guimond C, Duquette P, Sadovnick A (2003) The interaction of MS and pregnancy: a critical review. Int MS J 10:38–42
Ferrero S, Pretta S, Ragni N (2004) Multiple sclerosis: management issues during pregnancy. Eur J Obstet Gynecol Reprod Biol 115:3–9
Gnoth C, Schuring A, Friol K, Tigges J, Mallmann P, Godehardt E (2008) Relevance of anti-Mullerian hormone measurement in a routine IVF program. Hum Reprod 23:1359–1365
Goldenberg MM (2012) Multiple sclerosis review. Pharm Therapeut 37:175
Greer JM, McCombe PA (2011) Role of gender in multiple sclerosis: clinical effects and potential molecular mechanisms. J Neuroimmunol 234:7–18
Grinsted L, Heltberg A, Hagen C, Djursing H (1989) Serum sex hormone and gonadotropin concentrations in premenopausal women with multiple sclerosis. J Intern Med 226:241–244
Hedström A, Hillert J, Olsson T, Alfredsson L (2014) Reverse causality behind the association between reproductive history and MS. Mult Scler J 20:406–411
Hellwig K, Correale J (2013) Artificial reproductive techniques in multiple sclerosis. Clin Immunol 149:219–224
Huang H-F, He R-H, Sun C-C, Zhang Y, Meng Q-X, Ma Y-Y (2006) Function of aquaporins in female and male reproductive systems. Hum Reprod Update 12:785–795
Institute of Medicine (US) Committee on Multiple Sclerosis (2001) Characteristics and management of major symptoms. In: Joy JE, Johnston RB Jr (eds) Multiple sclerosis: current status and strategies for the future. National Academies Press, Washington, pp. 115–176. https://doi.org/10.17226/10031
Jalkanen A, Alanen A, Airas L, Sclerosis FM, Group PS (2010) Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler J 16:950–955
Kelsey TW, Wright P, Nelson SM, Anderson RA, Wallace WHB (2011) A validated model of serum anti-Müllerian hormone from conception to menopause. PLoS One 6:e22024
Kessler RA, Mealy MA, Levy M (2016) Treatment of neuromyelitis optica spectrum disorder: acute, preventive, and symptomatic. Curr Treat Options Neurol 18:2
Kim W, Kim S-H, Kim HJ (2011) New insights into neuromyelitis optica. J Clin Neurol 7:115–127
Kleiter I, Gold R (2016) Present and future therapies in neuromyelitis optica spectrum disorders. Neurotherapeutics 13:70–83
Koch-Henriksen N, Sørensen PS (2010) The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol 9:520–532
Le Page E, Leray E, Edan G, Group FMS (2011) Long-term safety profile of mitoxantrone in a French cohort of 802 multiple sclerosis patients: a 5-year prospective study. Mult Scler J 17:867–875
Lee JY et al (2012) Age-related distributions of anti-Müllerian hormone level and anti-Müllerian hormone models. Acta Obstet Gynecol Scand 91:970–975
Leroy C, Rigot JM, Leroy M, Decanter C, le Mapihan K, Parent AS, le Guillou AC, Yakoub-Agha I, Dharancy S, Noel C, Vantyghem MC (2015) Immunosuppressive drugs and fertility. Orphanet J Rare Dis 10:136
Love S (2006) Demyelinating diseases. J Clin Pathol 59:1151–1159
Łukaszuk K, Kunicki M, Liss J, Bednarowska A, Jakiel G (2014) Probability of live birth in women with extremely low anti-Müllerian hormone concentrations. Reprod BioMed Online 28:64–69
MacDonald SC, McElrath TF, Hernández-Díaz S (2018) Pregnancy outcomes in women with multiple sclerosis. Am J Epidemiol 188:57–66
Mikhael S, Punjala-Patel A, Gavrilova-Jordan L (2019) Hypothalamic-pituitary-ovarian axis disorders impacting female fertility. Biomedicines 7:5
Niedziela N, Adamczyk-Sowa M, Pierzchała K (2014) Epidemiology and clinical record of multiple sclerosis in selected countries: a systematic review. Int J Neurosci 124:322–330
Pandit L (2015) Neuromyelitis optica spectrum disorders: an update. Ann Indian Acad Neurol 18:S11
Pendergraft WF, McGrath MM, Murphy AP, Murphy P, Laliberte KA, Greene MF, Niles JL (2013) Fetal outcomes after rituximab exposure in women with autoimmune vasculitis. Ann Rheum Dis 72:2051–2053
Pittock SJ, Lucchinetti CF (2016) Neuromyelitis optica and the evolving spectrum of autoimmune aquaporin-4 channelopathies: a decade later. Ann N Y Acad Sci 1366:20–39
Portaccio E, Zipoli V, Siracusa G, Piacentini S, Sorbi S, Amato M (2003) Safety and tolerability of cyclophosphamide ‘pulses’ in multiple sclerosis: a prospective study in a clinical cohort. Mult Scler J 9:446–450
Roxburgh R et al (2005) Multiple Sclerosis Severity Score: using disability and disease duration to rate disease severity. Neurology 64:1144–1151
Sepúlveda M et al (2016) Pituitary-ovary axis and ovarian reserve in fertile women with multiple sclerosis: a pilot study. Mult Scler J 22:564–568
Swingler R, Compston D (1992) The morbidity of multiple sclerosis. QJM 83:325–337
Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, Correale J, Fazekas F, Filippi M, Freedman MS, Fujihara K, Galetta SL, Hartung HP, Kappos L, Lublin FD, Marrie RA, Miller AE, Miller DH, Montalban X, Mowry EM, Sorensen PS, Tintoré M, Traboulsee AL, Trojano M, Uitdehaag BMJ, Vukusic S, Waubant E, Weinshenker BG, Reingold SC, Cohen JA (2018) Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17:162–173
Thöne J, Kollar S, Nousome D, Ellrichmann G, Kleiter I, Gold R, Hellwig K (2015) Serum anti-Müllerian hormone levels in reproductive-age women with relapsing–remitting multiple sclerosis. Mult Scler J 21:41–47
Thöne J et al (2018) Ovarian reserve in women with neuromyelitis optica spectrum disorder. Front Neurol 9:446
Verkman AS, Ratelade J, Rossi A, Zhang H, Tradtrantip L (2011) Aquaporin-4: orthogonal array assembly, CNS functions, and role in neuromyelitis optica. Acta Pharmacol Sin 32:702–710
Verkman A, Phuan PW, Asavapanumas N, Tradtrantip L (2013) Biology of AQP4 and anti-AQP4 antibody: therapeutic implications for NMO. Brain Pathol 23:684–695
Visser JA, Schipper I, Laven JS, Themmen AP (2012) Anti-Müllerian hormone: an ovarian reserve marker in primary ovarian insufficiency. Nat Rev Endocrinol 8:331
Weber-Schoendorfer C, Schaefer C (2009) Multiple sclerosis, immunomodulators, and pregnancy outcome: a prospective observational study. Mult Scler J 15:1037–1042
Wingerchuk DM et al (2015) International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 85:177–189
Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A, (2018) Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 9(1):242. https://doi.org/10.4103/sni.sni_224_18
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This study was funded by Isfahan University of Medical Sciences.
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All participants gave written informed consent. All procedures performed were approved by the ethics committee of Isfahan University of Medical Sciences (the study code of 396539) and in accordance with the ethical standards of the institutional and/or national research committee and with the Code of Ethics of The World Association (Declaration of Helsinki) and its later amendments or comparable ethical standards.
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Sadeghpour, N., Mirmosayyeb, O., Bjørklund, G. et al. Is Fertility Affected in Women of Childbearing Age with Multiple Sclerosis or Neuromyelitis Optica Spectrum Disorder?. J Mol Neurosci 70, 1829–1835 (2020). https://doi.org/10.1007/s12031-020-01576-x
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DOI: https://doi.org/10.1007/s12031-020-01576-x