Importance of planning ovulation induction therapy in systemic lupus erythematosus and antiphospholipid syndrome: A single center retrospective study of 21 cases and 114 cycles*
Section snippets
Patients
We retrospectively reviewed the records of 21 consecutive women with SLE and/or APS who underwent OIT with or without attempted IVFET. Data of four cases (cases 10, 12, 17, 18) reported previously (5) were augmented during a longer follow-up period. Nineteen patients fulfilled the modified American College of Rheumatology criteria for SLE (9). Patients 2 and 4 fulfilled only three criteria.
Lupus anticoagulant (LA) was detected by activated partial thromboplastin time (PTT), diluted
Clinical characteristics at OIT onset
Mean age at OIT was 32 ± 4 years (range, 26-41). Mean infertility duration was 4 ± 3 years (range, 1-10). Primary infertility occurred in 10 women, and secondary in 11. Two women with APS had each one prior normal untreated pregnancy that occurred several years before thrombophlebitis while using estrogen-containing contraception. Four women had a history of fetal death, complicated by preeclampsia in one. Another woman had preeclampsia with premature delivery. Four women had histories of
Discussion
We followed 21 women with SLE or APS who underwent OIT for primary or secondary infertility. Five of them subsequently became pregnant spontaneously. This underlines the fact that infertility duration should always be taken into account for indication of OIT.
Conclusions
The OIT may complicate or reveal SLE or APS, and gynecologists should be aware of this danger. A careful history and screening is mandatory before OIT, based on obstetrical, thrombotic, hematologic, articular, or skin anomalies, especially if gonadotropin use is considered.
Complications of clomiphene therapy are rare.
On the contrary, when gonadotropins are prescribed, a preventive anti-inflammatory therapy should be considered in SLE patients, in addition to either heparin or anti-aggregant
Acknowledgements
The authors thank Pr Aumaitre (Clermont-Ferrand), Drs Audibert (Clamart), Bercau (Paris), Bulwa (Paris), Janse-Marec (Levallois-Perret), Le Hello (Caen), Loraillere (Bar le Duc), Priollet (Paris), Rolet (Neuilly), Rouffet (Chartres), Ruckstuhl (Beauvais), and Tournier (Besançon).
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Preconception, pregnancy, and lactation in systemic lupus erythematosus patients
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2021, Rheumatic Disease Clinics of North AmericaCitation Excerpt :Several observational studies support the potential role of estrogen in development and progression of SLE.7 Huong and colleagues31 found that, compared with clomiphene, the use of gonadotropins for ovulation induction increased the rate of SLE flares from 6% to 27%.7,31 Several risk factors for disease flare during pregnancy have been well described and are listed in Box 1.7,20–24,32
Assisted reproductive technologies for women with rheumatic AID
2020, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Patients with SLE who have long-standing disease may have renal, cardiac, and/or pulmonary insufficiency; cognitive dysfunction; stroke; infertility from cyclophosphamide; and osteoporosis and/or osteonecrosis from corticosteroid therapy. Despite early reports suggesting danger to patients with SLE undergoing ART [8], risk of carefully monitored ART is now thought to be low and manageable [9–12]. RA causes destructive, crippling arthritis, usually of the wrists, hands, elbows, knees, ankles, and feet (chapter 6), with resultant pain and limited or excessive motion of the affected joints.
Fertility and pregnancy in systemic lupus erythematosus
2020, Systemic Lupus Erythematosus: Basic, Applied and Clinical AspectsPregnancy and autoimmune disease, reproductive and hormonal issues
2018, Dubois' Lupus Erythematosus and Related SyndromesA comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus
2016, Journal of AutoimmunityCitation Excerpt :The introduction of LDA and/or LMWH does not seem to improve the pregnancy rate [161,172], even after multiple (>10) embryo-transfer failures [173]. Regarding efficacy, with a rate of success varying from 15.8 [165] to 30.7% [164], ARTs seem to perform well in SLE and APS patients. In conclusion, there are no clear reasons to discourage ARTs in SLE and/or APS patients, but the timing of the procedure has to be agreed with Rheumatologist in order to determine the moment assuring the best chances of success and to add an adequate pharmacological prophylaxis.
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Address reprint requests to Du Le Thi Huong, MD, PhD, Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, 83 bd de l'Hôpital, 75013 Paris, France.