Endocrine Abstracts

Introduction: Impaired fertility in women with Crohn’s disease compared to healthy women seems to be a consequence of Crohn’s disease, according to older studies. However, data are not consistent, and it is not clear why could the reduced fertility occur. Influence on ovarian reserve might be one of the answers.

Patients: The study group consisted of women with Crohn’s disease. The control group consisted of age and BMI matched healthy women with no history of assisted reproduction.

Methods: All patients completed a personal questionnaire, focused on fertility parameters as well as the Crohn’s disease phenotype, activity and treatment. Ovarian reserve was measured by the serum concentration of anti-mullerian hormone (AMH). In patients with Crohn’s disease, we investigated the effect of the Crohn’s disease phenotype and prior treatment on the ovarian reserve.

Results: We included 50 women with Crohn’s disease and 50 controls. Comparing two groups, we did not observe any difference in rates of birth, spontaneous abortion, contraceptive use and age of menarche. Serum AMH was not different between the groups (3.026 vs. 3.19, P=0.74), 54 vs. 52% of women had an optimal ovarian reserve (AMH>2.27), and 23.7 vs. 19.23% had low ovarian reserve (AMH <0.68), with no difference. Age was the strongest parameter affecting decline of the ovarian reserve, with not difference between patients with Crohn’s disease versus controls. We did not detect any significant impact of disease duration, type of disorder, inflammatory activity, or type of treatment on the rate of age-related AMH decline. However, we found a more pronounced age-related AMH decline in patients with prior IBD surgery compared to no surgery (slope -0.12 versus -0.29, P=0.04) and the trend towards the more pronounced decline in L2 colic phenotype compared to L1 and L3 (slope −0.33 vs. −0.14, P=0.12). Finally, women older than 30 years had a more pronounced age-related AMH decline if Crohn’s disease lasted for more than 5 years (slope −0.31 vs. −0.2, P=0.029).

Conclusion: We found that women with Crohn’s disease as compared to controls had the same ovarian reserve and equal rate of its age-related decline. More pronounced age-related decrease in ovarian reserve was observed in women with prior IBD surgery and those over 30 years of age with Crohn’s disease lasting for more than 5 years. In these cases, patients may be advised not to delay a pregnancy.