Background Subfertility is an important problem in younger female rheumatoid arthritis (RA) patients. Approximately 40% of these women have a time to pregnancy longer than 12 months, or do not get pregnant at all. This percentage is considerably higher than in the general population. Active disease and anti-rheumatic treatment have been shown to be associated with a reduced fertility in women with RA.(1) However, results of gynecological work-up in these women have not been reported in literature thus far.
Objectives To study the outcomes of fertility work-up in female RA patients.
Methods A cross-sectional study was performed in participants of a nationwide cohort of female RA patients who were pregnant or tried to conceive in 2002-2008 (PARA study).(2) All patients who had given consent for future contact (n=260) were sent a questionnaire on their reproductive history, visits to their gynecologist, fertility work-up and fertility treatments. Medical files were obtained from attending gynecologists to study diagnoses and performed fertility treatments.
Results A completed questionnaire was returned by 178 women (69%). The current age was 40.5±4.2 years. Most women (96%) had ended their efforts to conceive. Eighty-two subjects (46%) had at least one subfertile episode, and 56% of these patients were subfertile throughout their complete reproductive history. Subfertile women with RA had significantly less pregnancies and less children than fertile RA patients. In subfertile women, 50% (n=68) conceived at least once with the help of a fertility treatment, accounting for 17% of all pregnancies in the cohort.
Sixty-four (78%) of the subfertile women gave their consent for obtaining medical files from their attending gynecologist. Gynecological diagnoses (n=61) included: unexplained subfertility (41%), anovulation (27%), male subfertility (16%), endometriosis (6%) and other factors (all <5%).
Conclusions Unexplained subfertility and anovulation are the most common diagnoses in subfertile female RA patients. Especially unexplained subfertility is diagnosed more often than in the general subfertile population. Therefore, it is likely that RA related factors, such as severity of the disease, inflammation, and the use of anti-rheumatic drugs, are involved in subfertility in women with RA.
Brouwer J, Hazes JM, Laven JS, Dolhain RJ. Fertility in women with rheumatoid arthritis: Influence of disease activity and medication. Ann Rheum Dis 2014.
de Man YA, Dolhain RJ, van de Geijn FE, Willemsen SP, Hazes JM. Disease activity of rheumatoid arthritis during pregnancy: Results from a nationwide prospective study. Arthritis Rheum 2008;59:1241-8.
Acknowledgements This study is funded by the Dutch Arthritis Foundation (Reumafonds).
Disclosure of Interest None declared