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Rheumatology 2008 47(Supplement 3):iii38-iii41; doi:10.1093/rheumatology/ken156
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Treating infertility in autoimmune patients

M. Costa and D. Colia

Department of Preconceptional and Prenatal medicine, Galliera Hospital, Gonoa, Italy.

Correspondence to: M. Costa, Department of Preconceptional and Prenatal medicine, Galliera Hospital, Via Volta 6, 16145, Genoa, Italy. E-mail: mauro.costa{at}galliera.it


  Abstract

Fertility in patients with SLE and other systemic autoimmune disease is usually unaltered. However, fertility may be impaired by anovulation during episodes of active disease or chronic renal failure, administration of NSAIDs, high dose of corticosteroids and cyclophosphamide. Early pregnancy loss occurs in SLE patients with aPLs. An association of autoimmune disease with infertility has been suggested, but the studies are not conclusive. Ovulation stimulation as a fertility treatment could theoretically induce SLE. However, two recent studies did not find previous use of fertility drugs and in vitro fertilization to be more frequent in the history of SLE patients when compared with controls. Patients with SLE or primary APS, who are undergoing infertility treatment, could be at risk of flare or thrombosis. In the past 10 yrs, many reports have been published regarding the risk of lupus exacerbation associated with controlled ovarian hyperstimulation; not all found excess risk. At the moment we do not have any prospective study in this field. A trend towards a worse prognosis in cases of SLE patients undergoing assisted reproductive techniques (ARTs) for pregnancy rate, live-birth rate and maternal complications can be seen. If hormonal ovarian stimulation is useful, well-advised management would administer a low effective gonadotropin dose in a patient whose disease has been silent preferably for at least 6 months. Further data are needed to establish safety and efficacy of ART in SLE patients.

KEY WORDS: Systemic lupus erythematosus, Ovulation induction therapy, Infertility therapy, In vitro fertilization-embryo transfer

Submitted 18 March 2008; Accepted 28 March 2008


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