Pos0041 the Effect of Therapy of Methotrexate on Ovarian Reserve in Women With Rheumatoid Arthritis and Infertility

Background: Patients with rheumatoid arthritis, diagnosed even before the first pregnancy, have reduced fertility, for a longer period before the first pregnancy is compared to healthy women. A negative effect on the functioning of the reproductive system can have both the disease itself and the drug therapy. Objectives: Determine the indicators of the hormone antimuller - the main marker of the ovarian reserve in patients with rheumatoid arthritis and infertility who received and did not receive therapy methotrexate. Methods: The study included 32 patients with rheumatoid arthritis and infertility in age, which made up the main group, and 32 somatically healthy patients with infertility, comparable, duration and type of infertility - a comparison group. Patients with rheumatoid arthritis were stratified to 2 subgroups: 20 patients who received therapy with methotrexate 25 mg/week - 15 mg/week for 18.7 months and 17 patients who were not prescribed methotrexat. Both subgroups did not differ in age, duration and degree of activity of rheumatoid arthritis (P> 0.05). The hormone antimullahs were determined quantitatively using standard hemiluminated analysis on paramagnetic particles in blood serum. The normative values of the hormone antimuller is 1.0–10.6 ng/ml, the value of the hormone antimuller less than 1 ng/ml was regarded as a decrease in the ovarian reserve. Results: Patients with rheumatoid arthritis had lower indicators of the hormone antimuller when comparing with somatically healthy patients: 2.15 versus 2.73 ng/ml (p = 0.0429). They often diagnosed a decrease in the ovarian reserve: in 7 (21.8%) versus 2 (6.25%) patients (p = 0.015). The antimulleric hormone indicator in patients who received methotrexate (2.2 ng/ml) was lower than in patients without therapy (1.8 ng/ml) and in the comparison group (2.7 ng/ml) the identified tendency to reduce the indicator in the 1st subgroup did not reach a statistically significant difference, possibly due to a small sample. The level of antimulleric hormone in the blood serum naturally decreases with age. The correlation analysis of the dependence of the level of the age of patients with rheumatoid arthritis showed the most pronounced decrease in the antimuller hormone in the subgroup of patients who received methotrexate compared to the subgroup of methotrexate (R = -0.553; p <0.05). A weak negative correlation of the value of the antimulleric hormone with the age of the onset of therapy (R = –0.458; p <0.05) was noted. Conclusion: Patients with rheumatoid arthritis have lower indicators of the hormone antimuller and the use of methotrexate is associated with a more pronounced decrease in their ovarian reserve. The age of the onset of therapy of methotrexate negatively correlates with the meaning of the hormone antimuller. Patients with rheumatoid arthritis with compromised reproductive function and a decrease in the ovarian reserve planning therapy of methotrexate, the implementation of the reproductive potential at an earlier age or the preservation of genetic material before the treatment with methotrexate should be recommended. REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests: None declared.