Safety of fertility treatments in women with systemic autoimmune diseases (SADs)

ABSTRACT

Introduction: Systemic Autoimmune Diseases (SADs) include systemic lupus erythematosus, antiphospholipid antibody syndrome, rheumatoid arthritis, systemic sclerosis, Sjogren’s syndrome, mixed connective tissue disease, idiopathic inflammatory myopathies and vasculitis. SADs often occur in women of childbearing age and can affect fertility. Both infertility treatments and fertility preservation techniques are thus often indicated.

Areas covered: The literature regarding the safety of fertility-related drugs for both fertility preservation and infertility treatment in patients affected by SADs was reviewed. Based on current knowledge, all the options for fertility preservation should be contemplated in patients with SADs who are at risk for fertility loss, including GnRH analogue administration, oocyte/embryo vitrification and ovarian tissue cryopreservation. Similarly, if pregnancy is not contraindicated in a patient with a SAD, neither should be any fertility treatment.

Expert opinion: Women with SADs should postpone conception until a stable disease has been achieved for at least 6 months. When infertility treatments are needed, women with antiphospholipid antibodies should receive concomitant anticoagulation. If in vitro fertilization/intra-cytoplasmic sperm injection and embryo transfer is required, ovarian hyperstimulation and the inherent risk of thrombosis should be eliminated by GnRH-agonist trigger and cycle segmentation. Counselling about adherence to anti-rheumatic therapy to prevent disease exacerbations is also critical.

KEYWORDS:

• Infertility
• controlled ovarian stimulation
• in vitro fertilization
• fertility preservation
• assisted reproduction
• autoimmune diseases
• lupus
• antiphospolipid

Article highlights

• Systemic autoimmune diseases (SADs) may affect female fertility through disease-related and drug-related mechanisms. Careful monitoring of fertility status and counselling are recommended.

• Women with active SAD should postpone conception – either natural or assisted - until remission or stable disease have been achieved for at least 6 months.

• When pregnancy is not contraindicated in patients with SADs, infertility treatments are not contraindicated as well.

• Due to the necessity of a controlled disease, time to conception should be optimized in patients with SADs. Infertility investigations should be commenced after 6 months of failed natural attempts.

• Fertility preservation is recommended in patients with SADs needing gonadotoxic treatments and in patients in which significant delays in conception are expected and may result in age-related ovarian reserve exhaustion.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.