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Women With RA Face Reduced Likelihood of Live Birth After Assisted Reproductive Technology
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Women with rheumatoid arthritis who are treated with assisted reproductive technology, or ART, have a significantly reduced chance of live birth compared to those without rheumatoid arthritis, according to data published in the Annals of the Rheumatic Diseases.
“The relevance of examining the efficacy of ART treatment in women with RA is increasing as recent studies on other autoimmune diseases (ulcerative colitis and Crohn’s disease) have suggested a reduced chance of having a live born child after ART treatment compared with other women undergoing ART,” Bente Mertz Nørgård, PhD, DMSc, of Odense University Hospital, Denmark, and colleagues wrote.
“Those results indicated that the reduced chance might be related to difficulties with implantation of the transferred embryo,” the researchers noted. “Also, there is an ongoing debate whether corticosteroid drugs such as prednisolone can be used with beneficial effect in ART treatment.”
To analyze the chance of live birth following assisted reproductive technology treatment among women with RA, compared with those without RA, Nørgård and colleagues studied data from Danish health registries, focusing on women who received an embryo transfer from Jan. 1, 1994, through June 30, 2017. These registries included the Danish ART Registry, the Danish Medical Birth Registry, the Danish National Patient Registry, the Prescription Registry and the Central Personal Registry on death and immigration.
The researchers analyzed data on 1,149 embryo transfers in women with RA, and 198,941 in those without RA. The primary outcome was live birth per embryo transfer, controlled for multiple covariates. In addition, Nørgård and colleagues evaluated a chance of biochemical or clinical pregnancy after ART, as well as the possible effect of corticosteroid use prior to embryo transfer.
According to the researchers, the adjusted OR for a live birth was 0.78 per embryo transfer in women with RA compared with women without RA (95% CI, 0.65-0.92). In addition, the adjusted OR were 0.81 (95% CI, 0.68-0.95) for biochemical pregnancies, and 0.82 (95% CI, 0.59-1.15) for clinical pregnancies. Patients who received a prescription for corticosteroids before embryo transfer demonstrated an increased odds ratio for live birth (adjusted OR = 1.32; (95% CI, 0.85-2.05).
“Women with RA have a decreased chance of a live birth per embryo transfer compared with women without RA, and the problem might be related to impaired chance of embryo implantation,” Nørgård and colleagues wrote. “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.” – by Jason Laday
Disclosure: Nørgård reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Ellen M. Field, MD
The impact of pregnancy in women with RA continues to offer challenges for patients and their caregivers. Data suggests the number of women with RA during childbearing years is increasing, but the relative fertility rates were reduced after the diagnosis of RA; therefore, women with RA are more likely to seek ART compared with reference populations without RA.
Additionally, results in women with other autoimmune diseases, such as ulcerative colitis and Crohn’s disease, have demonstrated reduced chances of live births after ART. The mechanisms of these outcomes are unknown, but several factors have been postulated, including those related to fertilization, implantation and the success of pregnancy throughout each trimester until childbirth.
A nationwide Cohort Danish Study from Nørgård and colleagues demonstrated decreased chance of live birth in women with RA after ART, which had a study period of 23.5 years. The outcome showed that ART treatment in women with RA had a significantly decreased chance of live births per embryo transfer compared with ART treatment in women without RA. The results suggest that this was related to decreased chance of implantation of the embryo – both decreased chance of biochemical pregnancy after embryo transfer in women with RA and decreased chance of chemical pregnancy.
Additionally, the data suggest that RA patients who had corticosteroid prescribed before embryo transfer might have improved chance for a live birth compared to women with RA without a steroid prescription before embryo transfer.
There is ambiguity and no consensus view of the utility of steroids in ART, therefore these results may be considered speculative at this time pending further research. Perhaps the results are confounded by the disease activity and medicines used to control the disease. While this is the first study of the efficacy of ART in women with RA, future studies will be necessary to confirm these findings, and to identify other confounding factors that have yet to be determined on the potential outcomes in this population.
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Nørgård BM, et al. Ann Rheum Dis. 2018;doi:10.1136/annrheumdis-2018-214619.
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