Ovarian Function and Reproductive Outcomes of the Female Patients with Systemic Lupus Erythematosus and the Strategies to Preserve their Fertility

Abstract

Systemic lupus erythematosus (SLE) is a chronic auto-immune systemic disease that mainly affects women at reproductive age. Unfortunately, reproductive function of the young female patients suffering from this disease is commonly compromised by different etiologies. First, ovarian reserve is diminished even in the presence of mild disease suggesting a direct impact of the disease itself on ovarian function possibly due to ovarian involvement in the form of autoimmune oophoritis. Second, SLE patients with severe manifestations of the disease are treated with alkylating chemotherapy agent cyclophosphamide. Cyclophosphamide and other drugs of alkylating category have the highest gonadotoxicity. Therefore SLE patients exposed to cyclophosphamide have a much higher risk of developing infertility and premature ovarian failure than do the counterparts who are treated with other less toxic treatments. Third, the functions of the hypothalamic pituitary ovarian axis are pertubed by chronic inflammatory state. And finally adverse pregnancy outcomes are more commonly observed in SLE patients such as fetal loss, preterm birth, intrauterine fetal growth restriction, preeclampsia-eclampsia and fetal congenital heart blocks. We aimed in this review article to provide an update on the ovarian function and other reproductive outcomes in SLE patients, and the current strategies to preserve their fertility in the lights of the most recent guidelines of fertility preservation.