The impact of Sjögren's disease on ovarian reserve: a systematic review and meta-analysis

Because immune-mediated mechanisms in Sjögren's disease (SjD) may impair ovarian reserve, this study evaluated the association between SjD and ovarian reserve to inform fertility counselling and clinical management.

Following PRISMA 2020 guidelines (PROSPERO: CRD42025-1182803), we searched five databases (PubMed, Embase, Web of Science, Cochrane Library, and CBM) through December 1, 2025. Eligible observational studies quantitatively compared serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), antral follicle count (AFC), or ovarian volume (OV) between reproductive-age women with SjD and age-matched disease-free controls. Study quality was assessed using the Newcastle-Ottawa Scale and AHRQ tool, and continuous outcomes were synthesised using standardised mean differences (SMDs) with 95% confidence intervals (CIs).

Across four observational studies involving 410 participants, women with SjD exhibited significantly lower AMH levels compared with controls (SMD=-0.73, 95% CI -1.09 to -0.37; p<0.0001). Additionally, a trend toward higher FSH levels was observed (SMD=0.35, 95% CI 0.14 to 0.57; p<0.001), although statistical significance remained sensitive to the inclusion of specific studies. Conversely, no significant differences were observed for AFC (SMD=-0.58, 95% CI -1.70 to 0.55; p=0.31) or OV (SMD= -0.18, 95% CI -0.57 to 0.21; p=0.336).

Although limited data prevent definitive confirmation of how SjD affects ovarian reserve, this preliminary study strongly underscores the critical need for increased clinical awareness of the condition in reproductive medicine.