Fertility in women with rheumatoid arthritis: influence of disease activity and medication

Abstract

TTP in RA is longer if patients are older or nulliparous, have higher disease activity, use NSAIDs or use prednisone >7.5 mg daily. Preconception treatment strategies should aim at maximum suppression of disease activity, taking account of possible negative effects of NSAIDs use and higher prednisone doses.

Association between prior appendectomy and/or tonsillectomy in women and subsequent pregnancy rate: a cohort study

“…Similarly, untreated asthma significantly prolongs time to pregnancy and reduce fertility mainly because of systemic inflammation 21 . The same applies to untreated rheumatoid arthritis 22 . It is likely that the increased time to pregnancy in these disorders is biological rather than behavioural 15 .…”

Pregnancy and rheumatoid arthritis

“…Finally, mainly based on studies in oncology and in animal models, it has been suggested that prior treatment with MTX is associated with impaired fertility [12]. However, in a prospective cohort study on RA and fertility, prior MTX treatment did not affect TTP [9]. Furthermore, short-term MTX treatment had no impact on the ovarian reserve in patients with RA [13].…”

“…Clowse et al [8] reported that 36% of patients with RA had difficulties in conceiving at least once during their reproductive life span. In the Pregnancy-induced Amelioration of Rheumatoid Arthritis (PARA) study, a prospective Dutch cohort study on RA and pregnancy [9], it was shown that 42% of patients with RA did not conceive within 1 year or at all during the follow-up period of that study. For comparison, in the general population, the median prevalence of subfertility defined as TTP of >12 months is 9%, with a range of 3.5e24.2% depending on the geographic area [10,11].…”

“…Prostaglandins are involved in ovulation and implantation [12]. In addition, prednisone in a dose exceeding 7.5 mg daily has been associated with prolonged TTP [9]. The effect of prednisone might be related to a transient suppression of the hypothalamicepituitaryeovarian axis by glucocorticoids or by a direct effect on ovarian function or on the endometrium [14,15].…”

Medical problems in pregnancy

“…Good disease control is of obvious benefit to the mother but it also reduces adverse fetal and neonatal outcomes as well as improving fertility. 15 A 2013 meta-analysis showed that women who conceive with active inflammatory bowel disease have a higher rate of active disease during pregnancy (46-55%) than those who conceive while in remission (23-29%). 16 Similarly, systemic lupus erythromatosis flares during pregnancy are more common in those with active disease at conception.…”