January 11, 2018
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Ovarian marker abnormalities common in type 1 diabetes

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Women with type 1 diabetes may have abnormalities in ovarian markers, specifically anti-Müllerian hormone, as well as irregular menses, which may contribute to the risk for infertility, according to findings published in Clinical Endocrinology.

“Women with type 1 diabetes have a higher risk of infertility compared to women without diabetes, even after accounting for higher prevalence of irregular menses among women with type 1 diabetes,” the researchers wrote. “This higher risk has been attributed to suboptimal glycemic control as well as the higher prevalence of autoimmune disease, such as thyroid disorders, among women with type 1 diabetes. Women with type 1 diabetes may also have a higher prevalence of polycystic ovary syndrome, suggested by elevated levels of ovarian markers such as anti-Müllerian hormone (AMH) and testosterone, which are made by the gonads.”

Catherine Kim, MD, MPH, of the departments of medicine, obstetrics and gynecology, and epidemiology at the University of Michigan in Ann Arbor, and colleagues evaluated data from the DCCT/EDIC trial on 187 women (mean age, 35.4 years) with type 1 diabetes (mean diabetes duration, 14.4 years) to determine whether irregular menses, diabetes duration, BMI, glycemic control and insulin dosage are associated with abnormal concentrations in ovarian markers.

Mean baseline AMH concentration was 28.7 pmol/L, and mean baseline testosterone was 1.2 nmol/L.

Twenty-one percent of participants had a history of irregular menses and more than one-third had elevated AMH concentrations ( 26.7 pmol/L); 12.2% had testosterone concentrations of at least 1.74 nmol/L, and 2.7% had concentrations of at least 3.05 nmol/L. At least two reproductive abnormalities were reported in 16% of participants.

Participants with younger age, higher testosterone levels and irregular menses had higher AMH concentrations compared with their counterparts in unadjusted comparisons. Greater testosterone concentrations were associated with higher tertiles of AMH. No significant associations were observed between AMH and testosterone concentrations and tertiles of BMI, waist circumference, insulin dosage or glycemic control.

“The prevalence of abnormalities in ovarian markers, specifically elevations in AMH, is common in women with type 1 diabetes at an age where they are at increased risk for infertility. Irregular menses are also common although not associated with AMH, and elevations in testosterone are relatively uncommon,” the researchers wrote. “In conjunction with previous reports noting decreased fecundity in women with type 1 diabetes, our findings can be used to guide pregnancy planning and fertility management in women with type 1 diabetes in their 30s. Additional investigation of the reasons for decreased fecundity among women with type 1 diabetes should be conducted, particularly regarding abnormal AMH production.” – by Amber Cox

Disclosures: The study was supported by the NIH, the Genetic Clinical Research Centers Program and the Clinical Translational Science Center Program.