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Subfertility in women with RA often unexplained, caused by anovulation
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Subfertility in women with rheumatoid arthritis was most often unexplained or due to anovulation, according to recent findings, and unexplained diagnoses were associated with periconceptional nonsteroidal anti-inflammatory drug use.
Subfertility was previously associated with rheumatoid arthritis (RA) among women. Between 36% and 42% of women diagnosed with RA before conception had a time to pregnancy that exceeded 12 months, whereas this was only the case for 10% to 17% of women in the general population, according to the study background. There is no cause attributed to 8% to 28% of subfertility cases, which are known as unexplained subfertility.
To better understand unexplained subfertility, the researchers performed a cross-sectional study of women with RA who were pregnant or trying to conceive between 2002 and 2010, as part of the PARA cohort. Afterward, 178 of 260 women completed a questionnaire on reproductive history, fertility workup and fertility treatments. The researchers then obtained medical files from attending gynecologists.
Of those who completed the questionnaire, 96% previously ended their attempt to conceive. Forty-six percent had at least one subfertility episode. The two most common diagnoses were unexplained subfertility (48%) and anovulation (28%). Both occurred more commonly in patients with RA than the general population. In addition, women with unexplained subfertility more often used periconceptional nonsteroidal anti-inflammatory drugs (NSAIDs), according to the researchers. Seventeen percent of all pregnancies were conceived after fertility treatments, which had equal or higher pregnancy rates in RA compared with other subfertile populations.
These results suggest that RA may cause subfertility, they wrote. In addition, the outcome of fertility treatments in women with RA still remains favorable.
“In daily practice, when an RA patient wishes to conceive, NSAIDs should be avoided, and early consultation with an expert rheumatologist and a fertility specialist should be considered to optimize the patient’s chance of a complete family,” the researchers wrote. – by Will Offit
Disclosure : One researcher received an unrestricted research grant from UCB Pharma BV.
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