Reduced ovarian function in women with complex congenital heart disease.

Background: There is a high prevalence of menstrual disturbance in women with congenital heart disease (CHD). The purpose of this study was to evaluate ovarian function in women with CHD and factors associated with ovarian function. Design: Sixty-one women with more than moderate complexity of CHD who visited our hospital from March to December in 2019 were prospectively enrolled. We investigated menstrual bleeding patterns with a questionnaire. Serum anti-Müllerian hormone (AMH) levels, which reflect ovarian reserve, were measured in 43 women (28.1±8.7 years old) with CHD and 43 age-matched healthy women controls. Ratios of AMH levels to the median of reference values (provided by Beckman Coulter, Inc.) at each age were expressed as percentages (%AMH). The %AMH were evaluated for each clinical characteristic (oxygen saturation, NYHA class, Fontan circulation, cardiac complexity, physiological stage). Results: Menstrual cycle disorders were observed in 29 of 43 patients (68%) with CHD. The most frequent menstrual cycle disorder was frequent menstrual bleeding, observed in 14 patients (32%). Serum AMH levels were significantly lower in women with CHD than in controls (2.66±2.10 vs 4.55±4.02 ng/mL, P=0.008). The %AMH in women with Fontan circulation was significantly decreased, compared with those of controls [56.7 (1.1-152.4) % vs 94.6 (24.2-396.6) % P= 0.003]. The %AMH significantly reduced even in women with CHD whose oxygen saturation did not reduce (≧96%) [58.6 (4.9-313.9) % vs 94.6 (24.2-396.6) % P=0.033]. Conclusion: Measurements of AMH revealed reduced ovarian function that contributed to menstrual cycle disorders in patients with CHD.