Ovarian reserve assessment in crohn patients of reproductive age

Objectives: Crohn’s disease (CD) is a repeating bowel disease characterized by remission and exacerbation periods. The disease mostly affects adults of reproductive age. Women with desires to conceive are concerned about the effects of CD on their fertility. To demonstrate the relationship between ovarian reserve and CD anti-Müllerian hormone (AMH) levels, antral follicle count (AFC) and ovarian volüme were evaluated.

The prospective case-controlled study was conducted at a tertiary referral center in Istanbul between March–August 2019. Ovarian functions were evaluated in 50 patients with CD and in 95 healthy women. Serum gonadotropin and AMH levels were determined. AFCs and ovarian volumes were calculated for all subjects.

AMH levels were significantly lower in CD patients (2.1 ± 0.8) compared to the control group (3.3 ± 0.9) (p = 0.001). Serum AMH levels were significantly lower in patients with active CD (2.1 ± 0.6) than the CD patients in remission (2.6 ± 0.8) (p = 0.002). Ovarian volumes and AFC values were significantly lower in both ovaries in CD patients compared to the controls (p < 0.05).

AMH levels, ovarian volume and AFC counts, and thus ovarian reserve was shown to be decreased in CD patients of reproductive age compared to healthy control subjects. Because possible effects of inflammatory damage may be seen in newly diagnosed female CD patients who desire to have a child, we believe that CD patients should be comprehensively assessed for ovarian reserve.

anti-mullerian hormonecrohn diseaseinflammatory bowel diseaseovarian reserve

- Andres PG, Friedman LS. Epidemiology and the natural course of inflammatory bowel disease. Gastroenterol Clin North Am. 1999; 28(2): 255–81, vii. - Mountifield R, Bampton P, Prosser R, et al. Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflamm Bowel Dis. 2009; 15(5): 720–725. - Van Assche G, Dignass A, Reinisch W, et al. European Crohn's and Colitis Organisation (ECCO). The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations. J Crohns Colitis. 2010; 4(1): 63–101. - Moscandrew M, Kane S. Inflammatory bowel diseases and management considerations: fertility and pregnancy. Curr Gastroenterol Rep. 2009; 11(5): 395–399. - Mayberry JF, Weterman IT. European survey of fertility and pregnancy in women with Crohn's disease: a case control study by European collaborative group. Gut. 1986; 27(7): 821–825. - Hudson M, Flett G, Sinclair TS, et al. Fertility and pregnancy in inflammatory bowel disease. Int J Gynaecol Obstet. 1997; 58(2): 229–237. - Baird DD, Narendranathan M, Sandler RS. Increased risk of preterm birth for women with inflammatory bowel disease. Gastroenterology. 1990; 99(4): 987–994. - Broer SL, Mol BW, Hendriks D, et al. The role of antimullerian hormone in prediction of outcome after IVF: comparison with the antral follicle count. Fertil Steril. 2009; 91(3): 705–714. - Anckaert E, Öktem M, Thies A, et al. Multicenter analytical performance evaluation of a fully automated anti-Müllerian hormone assay and reference interval determination. Clin Biochem. 2016; 49(3): 260–267. - Leonhardt H, Gull B, Stener-Victorin E, et al. Ovarian volume and antral follicle count assessed by MRI and transvaginal ultrasonography: a methodological study. Acta Radiol. 2014; 55(2): 248–256. - Weber AM, Ziegler C, Belinson JL, et al. Gynecologic history of women with inflammatory bowel disease. Obstet Gynecol. 1995; 86(5): 843–847. - Woolfson K, Cohen Z, McLeod RS. Crohn's disease and pregnancy. Dis Colon Rectum. 1990; 33(10): 869–873. - Fonager K, Sørensen HT, Olsen J, et al. Pregnancy outcome for women with Crohn's disease: a follow-up study based on linkage between national registries. Am J Gastroenterol. 1998; 93(12): 2426–2430. - Zhang B, Meng Y, Jiang X, et al. IVF outcomes of women with discrepancies between age and serum anti-Müllerian hormone levels. Reprod Biol Endocrinol. 2019; 17(1): 58. - Lutchman Singh K, Muttukrishna S, Stein RC, et al. Predictors of ovarian reserve in young women with breast cancer. Br J Cancer. 2007; 96(12): 1808–1816. - Fréour T, Miossec C, Bach-Ngohou K, et al. Ovarian reserve in young women of reproductive age with Crohn's disease. Inflamm Bowel Dis. 2012; 18(8): 1515–1522. - Marri SR, Ahn C, Buchman AL. Voluntary childlessness is increased in women with inflammatory bowel disease. Inflamm Bowel Dis. 2007; 13(5): 591–599. - Wallace WH, Kelsey TW. Human ovarian reserve from conception to the menopause. PLoS One. 2010; 5(1): e8772. - van Rooij IAJ, Broekmans FJM, Scheffer GJ, et al. Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal study. Fertil Steril. 2005; 83(4): 979–987. - Zhao Y, Chen B, He Y, et al. Risk Factors Associated with Impaired Ovarian Reserve in Young Women of Reproductive Age with Crohn's Disease. Intest Res. 2020; 18(2): 200–209. - Fanchin R, Schonäuer LM, Righini C, et al. Serum anti-Müllerian hormone is more strongly related to ovarian follicular status than serum inhibin B, estradiol, FSH and LH on day 3. Hum Reprod. 2003; 18(2): 323–327. - Decanter C, Morschhauser F, Pigny P, et al. Anti-Müllerian hormone follow-up in young women treated by chemotherapy for lymphoma: preliminary results. Reprod Biomed Online. 2010; 20(2): 280–285. - Şenateş E, Çolak Y, Erdem ED, et al. Serum anti-Müllerian hormone levels are lower in reproductive-age women with Crohn's disease compared to healthy control women. J Crohns Colitis. 2013; 7(2): e29–e34. - Peyrin-Biroulet L, Loftus EV, Colombel JF, et al. The natural history of adult Crohn's disease in population-based cohorts. Am J Gastroenterol. 2010; 105(2): 289–297. - Arkuran C, McComb P. Crohn's disease and tubal infertility: the effect of adhesion formation. Clin Exp Obstet Gynecol. 2000; 27(1): 12–13. - Fielding JF, Cooke WT. Pregnancy and Crohn's disease. Br Med J. 1970; 2(5701): 76–77. - van der Heide F, Dijkstra A, Weersma RK, et al. Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis. Inflamm Bowel Dis. 2009; 15(8): 1199–1207. - Freour T, Masson D, Mirallie S, et al. Active smoking compromises IVF outcome and affects ovarian reserve. Reproductive BioMedicine Online. 2008; 16(1): 96–102.