In Vitro Fertilization is Safe and Effective in SLE and APS

In vitro fertilization (IVF) is safe and effective in women with systemic lupus erythematosus (SLE) or antiphospholipid syndrome (APS) who are in clinical remission, according to a study published in The Journal of Rheumatology.

In women with SLE or APS, hormonal changes in pregnancy increase the risk for thrombosis, SLE flares, and pregnancy-related complications. Although fertility is usually normal in this population, some women will experience infertility and may pursue IVF. Because IVF relies on hormonal manipulation, this procedure may raise the risk of SLE flares and thrombosis. However, data examining the risk of IVF in women with SLE and APS is limited.

Researchers evaluated the rates of complications and success for IVF in women with SLE or APS in a retrospective study.

A total of 37 women with SLE or APS who were in clinical remission and receiving adequate treatment underwent 97 IVF procedures. Treatment for SLE and APS most commonly included steroids, hydroxychloroquine, aspirin, and low molecular weight heparin. Nearly all IVF cycles were supervised by an internist.

The pregnancy rate was 28% and the live birth rate was 85%. The majority (70%) of women who underwent IVF delivered at least 1 healthy child.

“We observed no statistically significant relation between APS or [antiphospholipid antibodies (aPL)] and the IVF pregnancy rate, which was 25% in women with APS or aPL and 32% in patients without (P = .63). It should be noted that the relation between aPL and poor outcome in assisted reproduction treatment is controversial,” the researchers wrote.

Complications associated with IVF occurred in 8% of procedures and included 4 SLE flares and 4 thromboembolic events, all of which were observed in cycles that used gonadotropin-releasing hormone in ovarian induction protocols. There were no instances of ovarian hyperstimulation syndrome.

A total of 4 additional SLE flares and thromboembolic events occurred in the context of nonadherence to SLE or APS treatment after the IVF cycle failed. These complications were considered potentially preventable.

During the 27 pregnancies resulting from successful IVF procedures, there were 6 mild SLE flares and 1 deep vein thrombosis. Preterm birth occurred in 37% of pregnancies, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome in 15%, and preeclampsia in 7%.

Summary & Clinical Applicability

Women who have SLE and APS and are infertile may choose to pursue IVF. However, there are concerns that IVF-associated hormonal manipulation may increase the risk for SLE flares, thrombosis, and pregnancy-related complications. Researchers reported the success and complication rates of IVF in women with SLE and APS.

“The pregnancy and live-birth rates were close to what is expected in the general population (28% and 85%, respectively). These results confirm that IVF can be safely and successfully performed in women with SLE and/or APS who are in remission and receiving adequate treatment,” the researchers wrote.

Study Limitations

• The small sample size and retrospective nature of this study may subject the study to bias
• Oocyte donation cycles were used in 15 IVF procedures, which involve a milder stimulation induction protocol than procedures that include ovarian stimulation protocols

Reference

Orquevaux P, Masseau A, Le Guern V, et al. In vitro fertilization in 37 women with systemic lupus erythematosus or antiphospholipid syndrome: a series of 97 procedures. [published online January 15, 2017] J Rheumatol. doi: 10.3899/jrheum.160462

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