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Peer-reviewedCC BY 4.0Frontiers in Immunology

Diminished ovarian reserve in systemic lupus erythematosus: clinical, immunological, viral, and therapeutic determinants in a 24-month prospective study

  • Margherita Rizzo1,2
  • Silvia Beltrami3
  • Francesca Ruffilli1,2
  • Carlo Garaffoni1
  • Ettore Silvagni1,2
  • Daria Bortolotti3
  • Giorgia Cianci3
  • Maila Galloppa1
  • Beatrice Maranini1
  • Marcello Govoni1,2
  • Roberta Rizzo3
  • Alessandra Bortoluzzi1,2
  1. 1Rheumatology Unit, Azienda Ospedaliero-Universitaria Sant’Anna
  2. 2Department of Medical Sciences, University of Ferrara
  3. 3Department of Environmental and Prevention Sciences, University of Ferrara
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Abstract

Background and objectives: Systemic lupus erythematosus (SLE) predominantly affects women of reproductive age; however, the impact of the disease, chronic inflammation, and its treatments on ovarian reserve remains insufficiently characterized. This study aimed to assess the prevalence of diminished ovarian reserve in SLE and to evaluate the longitudinal associations of clinical characteristics, therapeutic exposures, and herpesvirus serologies with Anti-Müllerian Hormone (AMH) levels.

Methods: This observational prospective monocentric study followed 80 premenopausal women (18–45 years) with SLE for 24 months. Clinical data, treatments, AMH levels, and herpesvirus serologies were collected every 6 months. Patients were stratified by diminished ovarian reserve (AMH <1 ng/mL). Longitudinal AMH trajectories and the impact of covariates were evaluated using repeated-measures analyses and linear mixed-effects models.

Results: The cohort exhibited a high prevalence of diminished ovarian reserve (45% of the study population), associated with older age (37 ± 7 vs. 34 ± 7 years, p = 0.041), longer disease duration (14 ± 9 vs. 10 ± 6 years, p = 0.026), higher cumulative damage (p = 0.007), and lupus anticoagulant positivity (14% vs. 39%, p=0.009). Disease activity was comparable across groups. Hydroxychloroquine use was more frequent in women without diminished ovarian reserve (89% vs 69%, p = 0.033). Over 24 months, AMH levels remained stable with no progressive decline. Belimumab exposure did not adversely affect AMH trajectories, and viral serologies showed no direct long-term impact on AMH levels.

Conclusions: This prospective longitudinal study highlights that diminished ovarian reserve is common in women with SLE. AMH levels remained stable over 24 months, with no adverse longitudinal association with belimumab exposure. Hydroxychloroquine use was associated with a lower prevalence of diminished ovarian reserve and warrants further investigation. Serial AMH assessment may support personalized reproductive counselling in women with SLE.

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Cite

BibTeXRIS
BibTeX
@article{rizzo2026diminished,
  title = {{Diminished ovarian reserve in systemic lupus erythematosus: clinical, immunological, viral, and therapeutic determinants in a 24-month prospective study}},
  author = {Margherita Rizzo and Silvia Beltrami and Francesca Ruffilli and Carlo Garaffoni and Ettore Silvagni and Daria Bortolotti and Giorgia Cianci and Maila Galloppa and Beatrice Maranini and Marcello Govoni and Roberta Rizzo and Alessandra Bortoluzzi},
  journal = {Frontiers in Immunology},
  year = {2026},
  month = oct,
  doi = {10.3389/fimmu.2026.1918504},
  url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1918504/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Diminished ovarian reserve in systemic lupus erythematosus: clinical, immunological, viral, and therapeutic determinants in a 24-month prospective study
AU  - Margherita Rizzo
AU  - Silvia Beltrami
AU  - Francesca Ruffilli
AU  - Carlo Garaffoni
AU  - Ettore Silvagni
AU  - Daria Bortolotti
AU  - Giorgia Cianci
AU  - Maila Galloppa
AU  - Beatrice Maranini
AU  - Marcello Govoni
AU  - Roberta Rizzo
AU  - Alessandra Bortoluzzi
PY  - 2026
DA  - 2026/10/14
JO  - Frontiers in Immunology
DO  - 10.3389/fimmu.2026.1918504
UR  - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1918504/full
AB  - Background and objectives: Systemic lupus erythematosus (SLE) predominantly affects women of reproductive age; however, the impact of the disease, chronic inflammation, and its treatments on ovarian reserve remains insufficiently characterized. This study aimed to assess the prevalence of diminished ovarian reserve in SLE and to evaluate the longitudinal associations of clinical characteristics, therapeutic exposures, and herpesvirus serologies with Anti-Müllerian Hormone (AMH) levels.  Methods: This observational prospective monocentric study followed 80 premenopausal women (18–45 years) with SLE for 24 months. Clinical data, treatments, AMH levels, and herpesvirus serologies were collected every 6 months. Patients were stratified by diminished ovarian reserve (AMH <1 ng/mL). Longitudinal AMH trajectories and the impact of covariates were evaluated using repeated-measures analyses and linear mixed-effects models.  Results: The cohort exhibited a high prevalence of diminished ovarian reserve (45% of the study population), associated with older age (37 ± 7 vs. 34 ± 7 years, p = 0.041), longer disease duration (14 ± 9 vs. 10 ± 6 years, p = 0.026), higher cumulative damage (p = 0.007), and lupus anticoagulant positivity (14% vs. 39%, p=0.009). Disease activity was comparable across groups. Hydroxychloroquine use was more frequent in women without diminished ovarian reserve (89% vs 69%, p = 0.033). Over 24 months, AMH levels remained stable with no progressive decline. Belimumab exposure did not adversely affect AMH trajectories, and viral serologies showed no direct long-term impact on AMH levels.  Conclusions: This prospective longitudinal study highlights that diminished ovarian reserve is common in women with SLE. AMH levels remained stable over 24 months, with no adverse longitudinal association with belimumab exposure. Hydroxychloroquine use was associated with a lower prevalence of diminished ovarian reserve and warrants further investigation. Serial AMH assessment may support personalized reproductive counselling in women with SLE.
SN  - 1664-3224
ER  -