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P173 Subfertility in young women and men patients with Crohn´s disease

Rodríguez, A.(1);Herreros, B.(2);Muñoz, R.(1);Sempere, L.(1);Sirera, P.(3);González-Bueno, V.(3);Torregrosa, M.E.(3);Alfayate, R.(3);Orts, B.(4);Zapater, P.(5);Tejedo, D.(6);Moreno-Pérez, O.(7);Gutiérrez, A.(8);

(1)Hospital General Universitario Alicante, Gastroenterology, Alicante, Spain;(2)Hospital Marina Baixa, Gastroenterology, Villajoyosa, Spain;(3)Hospital General Universitario Alicante, Clinical Laboratory Department, Alicante, Spain;(4)Hospital General Universitario Alicante, Clinical Pharmacology, Alicante, Spain;(5)Hospital General Universitario Alicante- CIBERehd- ISABIAL- Universidad Miguel Hernández de Elche, Clinical Pharmacology, Alicante, Spain;(6)Hospital General Universitario Alicante, Endocrinology, Alicante, Spain;(7)Hospital General Universitario Alicante- ISABIAL- Universidad Miguel Hernández de Elche, Endocrinology, Alicante, Spain;(8)Hospital General Universitario Alicante- CIBERehd ISABIAL, Gastroenterology, Alicante, Spain

Background

Crohn’s disease (CD) affects young adults on reproductive age. They are likely to desire pregnancy and are often concerned about the potential effects of inflammatory bowel disease on fertility. Aims to investigate the effect of CD in fertility, studying the ovarian reserve in women by serum anti-Müllerian hormone (AMH) and Sertoli cell function in men measured by serum Inhibine (IB).

Methods

Cross-sectional, prospective, case-control study, including CD patients, aged 18-40 yr, and healthy controls(HC) matched by gender and age(ratio 2:1). Morning IB was measured using ELISA. Serum AMH was measured by ECLIA. Sociodemographic and phenotypic features of CD patients and controls were collected. We defined impaired fertility potential as IB level < 89 pg/mL and AMH <1.66 ug/L 0-24 yr, <1. 18 ug/L 25-29 yr, <0.67 ug/L 30-34 yr, <0.77 ug/L 35-39 yr, <0.01 ug/L  40-44 yr. AMH < 2 ug/L under 40 yr was considered low.

Results

A total of 122 subjects were included:73 men(48 CD, 25 HC) and 49 women(21 CD, 28 HC). No statistical difference was found between mean serum AMH levels in CD and HC women(2,23±1,8 vs 2,86±1,9 ug/L, p=0,5). The rate of abnormal serum AMH levels according to age did not differ between groups (19% CD vs 25% HC, p=0,4). When classified according to age(<30 and >30 yr), the serum AMH levels remained comparable in <30 yr (3.3±2.06 CD vs 3,2±1.96 ug/L HC, P=0.9). However, a low AMH level(<2 ug/L) was measured in 13 CD women(61%) and in 9 HC(32%)(P < 0.03), especially  in>30 yr, 9 CD(90%)vs 4 in HC(40%)(p=0.02). Serum IB levels were significantly lower in CD men vs HC (175.4 ±62.3 vs 234.12±75.56 ug/L, p=0.002). We did not find abnormal IB(<89 pg/mL) in HC vs 3(6%) among CD men. 

Table 1.Clinical features of CD patients

Female CD   (n=25)     Male CD       (n=48)
Mean age, yr (SD)  28.6 (6.7) 29.5 (7)
IBD duration, yr (SD)  7.8 (5.3) 8.4 (5.9)
Montreal A1/A2, n (%)3 (14.3) / 18 (85.7)  8 (16.7) / 40 (83.3)
Montreal L1/L2/L3/L4, n (%)7 (33.3) / 4 (19) / 10 (47.6) / 021 (43.8) / 6 (12.5) / 20 (41.7) / 1 (2.1)
Montreal B1/B2/B3, n (%)17 (81) / 3 (14.3) / 1 (4.8)31 (64.6) / 8 (16.7) / 9 (18.8) 
Perianal disease n (%)4 (19)11 (22.9)
Extraintestinal disorders, n ( %)4 (19)8 (16.7)
Abdominal surgery, n (%)3 (14.3)11 (22.9)
Perianal surgery, n (%)3 (14.3)6 (12.5)
Steroids, Immunosuppressant, Biologics n (%) 4 (19); 5 (23.8); 15 (71.4) 3 (6.3); 7 (14.6); 35 (72.9)

Conclusion

Women with CD did not have severe ovarian reserve alterations compared to a control population. However higher proportion of CD women showed low AMH (< 2 ug/L), especially those > 30 years. These data could be helpful for female CD patients who want to have children. Inhibine levels, as biomarker of Sertoli cell function, were lower in CD men compared to healthy controls.

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