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Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study
  1. Bente Mertz Nørgård1,2,3,4,
  2. Michael Due Larsen1,2,
  3. Sonia Friedman2,3,4,
  4. Torben Knudsen5,
  5. Jens Fedder6,7
  1. 1 Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
  2. 2 Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  3. 3 Crohn’s and Colitis Center, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  4. 4 Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Department of Medical Gastroenterology, Hospital of Southwest Jutland, Esbjerg, Denmark
  6. 6 Department D, Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
  7. 7 Research Unit of Human Reproduction, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Professor Bente Mertz Nørgård, Center for Clinical Epidemiology, Odense University Hospital, Odense 5000, Denmark; bente.noergaard{at}rsyd.dk

Abstract

Objectives No studies have examined the efficacy of assisted reproductive technology (ART) treatment in women with rheumatoid arthritis. Therefore, we examined the chance of live birth after ART treatment in women with rheumatoid arthritis compared with women without rheumatoid arthritis.

Methods Our cohort study is based on nationwide Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 30 June 2017. The cohorts comprised 1149 embryo transfers in women with rheumatoid arthritis, and 198 941 embryo transfers in women without rheumatoid arthritis. Our outcome was live birth per embryo transfer, and we controlled for multiple covariates in the analyses. In subanalyses, we examined a chance of biochemical/clinical pregnancy after ART and a possible impact of corticosteroid use prior to embryo transfer.

Results The adjusted OR (aOR) for a live birth per embryo transfer in women with rheumatoid arthritis, relative to women without rheumatoid arthritis, was 0.78 (95% CI 0.65 to 0.92). The aORs for biochemical and clinical pregnancies were 0.81 (95% CI 0.68 to 0.95) and 0.82 (95% CI 0.59 to 1.15), respectively. Corticosteroid prescription prior to embryo transfer increased the OR for live birth (aOR=1.32 (95% CI 0.85 to 2.05)).

Conclusions The chance of a live birth was significantly reduced in women with rheumatoid arthritis receiving ART treatment, relative to women without rheumatoid arthritis, and our result suggested that the problem was related to an impaired chance of embryo implantation. The role of corticosteroid use prior to embryo transfer must be a subject for further research.

  • rheumatoid arthritis
  • assisted reproductive technology
  • in vitro fertilisation
  • clinical epidemiology
  • reproduction
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Footnotes

  • Handling editor Josef S Smolen

  • Contributors BMN: conception, funding, design, data collection, assistance with data analyses, interpretation of results, manuscript writing and editing, approved the final version. MDL: data collection, data analyses, interpretation of results, manuscript editing, approved the final version. SF and TK: interpretation of results, manuscript editing, approved the final version. JF: assistance with data analyses, interpretation of results, manuscript editing, approved the final version.

  • Funding The study was supported by the Research Foundation of the Region of Southern Denmark, and the Free Research Foundation at Odense University Hospital, Denmark.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency (j.nr. 2012-58-0018, 17/37434). According to Danish law, there are no ethical approvals of register-based studies necessary.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional data available.

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