Ovarian reserve does not predict the course of multiple sclerosis, according to a Vall d’Hebron study

A study led by the Clinical Neuroimmunology Group at the Vall d’Hebron Research Institute (VHIR) and the Multiple Sclerosis Centre of Catalonia (Cemcat) has concluded that ovarian ageing, measured at disease onset through anti-Müllerian hormone (AMH) levels, has no predictive value for the course of multiple sclerosis or for long-term disability. The study, published in the Journal of Neurology, Neurosurgery and Psychiatry, involved collaboration with the VHIR groups in Clinical Biochemistry, Drug Delivery and Therapy, Neuroradiology, and Maternal and Fetal Medicine, as well as with the Gregorio Marañón University Hospital and Ramón y Cajal University Hospital.

Anti-Müllerian hormone is a protein produced by the ovaries that is commonly used as an indicator of ovarian reserve, that is, the number of remaining oocytes in women. This reserve naturally declines with age and is one of several factors that may be associated with biological ageing in women. Previous studies had proposed AMH as a potential biomarker associated with disease activity and prognosis in women with multiple sclerosis.

To investigate this relationship, the research team analysed prospective data from three hospitals: Vall d’Hebron University Hospital in Barcelona and the Gregorio Marañón and Ramón y Cajal University Hospitals in Madrid.

The study included 365 women aged between 20 and 45 years who had experienced a first episode suggestive of multiple sclerosis and whose AMH levels had been measured shortly after their first demyelinating event. The patients were followed for several years to assess different indicators of disease progression, including the occurrence of a second relapse, disability progression, and the diagnosis of multiple sclerosis according to the McDonald criteria.

No association between AMH and the course of multiple sclerosis

The results show that anti-Müllerian hormone levels are not associated with either a better or a worse prognosis in multiple sclerosis. “When we adjust for patient age, we demonstrate that this hormone has no predictive value. The possible association observed in previous studies between AMH and prognosis appears to be largely explained by patients’ age, with which this hormone is closely correlated”, explains Dr. Álvaro Cobo Calvo, neurologist in the Department of Neurology at Vall d’Hebron University Hospital and Cemcat, and researcher in the Clinical Neuroimmunology group at VHIR.

Chronological age—that is, a patient’s actual age in years—is one of the most relevant factors in the prognosis of multiple sclerosis: older individuals at disease onset tend to develop greater disability. Although older women generally have lower AMH levels, the levels of this hormone do not exert an independent effect on disease progression.

The researchers also compared AMH levels in patients with multiple sclerosis with those of 145 healthy women and found no differences between the two groups.

These findings have important implications for clinical practice, particularly in providing evidence-based information to women with diminished ovarian reserve or premature ovarian insufficiency. “These results help clarify a question that had generated considerable interest in previous studies but had not been confirmed in cohorts of this size or with such rigorous statistical adjustment. We have confirmed that low ovarian reserve is not an additional risk factor for long-term disability”, concludes Dr. Mar Tintoré, Clinical Head of the Department of Neurology/Neuroimmunology at Vall d’Hebron University Hospital and Cemcat, and principal investigator of the Clinical Neuroimmunology group at VHIR.