An observational multicentre study on the efficacy and safety of assisted reproductive technologies in women with rheumatic diseases

Abstract

Objectives The aim was to determine whether assisted reproductive technologies (ARTs) confer additional risk in rheumatic patients (in terms of disease flare and fetal–maternal complications) and whether, if performed, their efficacy is affected by maternal disease. Methods Sixty infertile rheumatic women undergoing 111 ART cycles were included. Clinical pregnancy rate, live birth rate, maternal disease flares and maternal–fetal complications were recorded. Results One hundred and eleven ART cycles in 60 women were analysed. We reported 46 pregnancies (41.4%), 3 (3.1%) cases of ovarian hyperstimulation syndrome and no cases of thrombosis during stimulation, pregnancy and puerperium. One or more maternal complication was reported in 13 (30.2%) pregnancies, and fetal complications occurred in 11 fetuses (21.1%). The live birth rate was 98%, but we reported three (6%) perinatal deaths in the first days of life. During puerperium, we recorded one (2.5%) post-partum haemorrhage and one (2.5%) articular flare. Conclusion The safety and efficacy of the ARTs, demonstrated in the general population, seems to be confirmed also in rheumatic patients. No evidence was found to advise against their application, and the choice of therapy should be made depending on the patient’s risk profile, irrespective of whether the pregnancy is natural or artificial induced.

Pregnancy outcomes in patients receiving assisted reproductive therapy with systemic lupus erythematosus: a multi-center retrospective study

“…The efficacy of ART in terms of clinical pregnancy rate in our study (46.5%) is comparable with that in the general population from the same center (57.1%) [12]. In previous studies, nearly 41.4% of patients with connective tissue diseases (CTD) became clinically pregnant via ART [13]. Previous and current findings suggest that ART is an effective method for infertility in patients with SLE.…”

Evaluation of the Ovarian Reserve in Women With Systemic Lupus Erythematosus

“…The risks of those pregnancies include flares of disease, preeclampsia, fetal loss, and preterm birth ( 4 , 17 ). Alternatively to natural pregnancies, assisted reproduction techniques (ART) offer the same safety and efficacy as in the general population and have been successfully performed in SLE patients ( 23 , 24 ).…”

Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases

“…Among connective tissue diseases (CTDs), SLE and APS are the most relevant during childbearing age. Observational nationwide studies conducted in France [59] and Italy [60] showed that ARTs, especially IVF, can be safely and successfully performed in women with SLE and/or APS who become pregnant during a period of disease remission and carefully adhere to medications for the prevention of SLE flares and thrombotic events. Active SLE, poorly controlled arterial hypertension, advanced renal disease, and major previous thrombotic events are situations in which ARTs should not be performed, due not only to the risks linked to ARTs but also to the subsequent pregnancy.…”