At Age 30-Plus, IBD Spurs Primordial Follicles' Loss


SAN FRANCISCO — Inflammatory bowel disease does not severely alter ovarian reserve but may accelerate loss of primordial follicles in those aged 30 years and older, results from a clinical study showed.

The investigators measured anti-müllerian hormone—which is a reliable hormonal marker for evaluating ovarian reserve independently of the menstrual cycle—in 44 women aged 20–41 years who had IBD and were in clinical remission after infliximab treatment for either Crohn's disease (37 patients) or ulcerative colitis (in 7 patients).

The hormone levels were compared with those of 163 age-matched women undergoing in vitro fertilization who had a normal ovarian response to controlled ovarian stimulation (5–15 oocytes retrieved) and a normal serum anti-müllerian hormone level (greater than 1.5 mcg/L).

The anti-müllerian hormone levels did not differ significantly overall between the IBD and control patients (2.72 vs. 2.12 mcg/L), Dr. Thomas Fréour reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

However, when the women were stratified by age 30 years and older versus age less than 30 years, the anti-müllerian hormone levels were found to differ in the older women, with those aged 30 years and older having lower levels than controls (2 vs. 2.96 mcg/L).

The levels in the younger patients remained comparable in the patients and controls, said Dr. Fréour of the University Hospital Center of Nantes (France).

Inflammatory bowel disease has been shown in previous studies to be associated with female subfertility, mainly through tubal dysfunctions, extensive adhesions, or chirurgical consequences on pelvic function, but alteration of ovarian reserve in those with IBD had not been previously studied, Dr. Fréour noted.

The findings suggest that in reproductive age women 30 years and older who have IBD, a substantially accelerated loss of primordial follicles may occur.

This loss might be attributed to chronic inflammation and/or to IBD treatments, he noted, adding that although the findings need to be confirmed in a larger population, they could be helpful for counseling women with IBD about their future prospects of fertility.

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