Women with rheumatoid arthritis (RA) undergoing assisted reproductive technology (ART) treatment are significantly less likely to have a live birth compared with women without RA, according to study results published in the Annals of the Rheumatic Diseases.

The results indicated that this lower live birth rate is related to an impaired chance of embryo implantation.

The study included all women with an embryo transfer in Danish health registries from January 1, 1994 through June 30, 2017. The researchers identified 198,941 embryo transfers in women without RA and 1149 in women with RA. The primary outcome was live birth per embryo transfer. In a sub-analysis, the researchers examined the chance of biochemical or clinical pregnancy after ART and a possible effect of corticosteroid use before embryo transfer.

The researchers found that the adjusted odds ratio (aOR) for a live birth per embryo transfer in women with RA was 0.78 (95% CI, 0.65-0.92) compared with women without RA.

In the sub-analysis, the researchers found that the aORs for biochemical and clinical pregnancies in women with RA were 0.81 (95% CI, 0.68-0.95) and 0.82 (95% CI 0.59-1.15), respectively.

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The results also indicated that corticosteroid prescription prior to embryo transfer actually increased the OR for live birth in women with RA (aOR, 1.32; 95% CI, 0.85-2.05).

“Our results on the role of corticosteroid prior to embryo transfer are not unambiguous, and future studies must examine the mechanisms between corticosteroid, and other medications for RA, in relation to fertilization and implantation,” the researchers wrote.

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Reference

Norgard BM, Larsen MD, Friendman S, et al. Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study [published online January 12, 2019]. Ann Rheum Dis. doi:10.1136/ annrheumdis-2018-214619