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Rheumatology Advance Access published online on July 26, 2008
Rheumatology, doi:10.1093/rheumatology/ken293
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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

Fertility preservation treatment for young women with autoimmune diseases facing treatment with gonadotoxic agents

S. E. Elizur1, R. C. Chian1, C. A. Pineau2, W. Y. Son1, H. E. G. Holzer1, J. Y. J. Huang1, Y. Gidoni1, D. Levin1, E. Demirtas1 and S. L. Tan1

1Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill Reproductive Center, McGill University Health Center and 2Division of Rheumatology, Department of Medicine, McGill University Health Center Lupus Clinic, Montreal, Quebec, Canada.

Correspondence to: S. E. Elizur, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Quebec H3A 1A1, Canada. E-mail: shai.elizur{at}gmail.com


  Abstract

Objective. To describe a case series of seven women with SLE and other systemic autoimmune rheumatic diseases (SARDs) who required cyclophosphamide therapy and underwent fertility preservation treatments.

Methods. Of the seven patients reported here, five women had SLE with nephritis, the sixth had immune thrombocytopenia purpura (ITP) and the seventh had microscopic polyangiitis (MPA) with renal involvement. All women were nulliparous and younger than 35 yrs.

Results. Patients with SLE underwent in vitro maturation (IVM) of immature oocytes aspirated during a natural menstrual cycle followed by vitrification of the matured oocytes if a male partner was not available, or vitrification of embryos if one was available. The patient with ITP and the patient with MPA underwent gonadotropin ovarian stimulation followed by oocyte or embryo vitrification. All women completed fertility preservation treatment successfully and mature oocytes or embryos (36 and 13, respectively) were vitrified. No complications were associated with this treatment and cytotoxic therapy was initiated as scheduled in all cases.

Conclusions. Oocyte or embryo cryopreservation should be considered for fertility preservation in young women with SARDs who face imminent gonadotoxic treatment. In patients, where gonadotropin ovarian stimulation is deemed unsafe, IVM of immature oocytes, aspirated during a natural menstrual cycle, followed by vitrification or fertilization of the mature oocytes, seems to be safe and feasible. For patients in whom hormonal ovarian stimulation is not contraindicated, this method may be considered depending on the urgency to start cytotoxic therapy.

KEY WORDS: Systemic lupus erythematosus, Fertility preservation, Vitrification, In vitro maturation, Systemic autoimmune rheumatic diseases

Submitted 23 May 2008; Accepted 25 June 2008


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