Assistive reproductive therapy shows ‘satisfactory outcomes’ in patients with stable lupus
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Assistive reproductive therapy is safe and demonstrates “satisfactory outcomes” in patients with systemic lupus erythematous in stable disease, according to data published in Arthritis Research & Therapy.
“Assisted reproductive therapy (ART) is a well-developed technique for infertility and is widely used in the general population,” Minxi Lao, MD, of the department of rheumatology at The First Affiliated Hospital of Sun Yat-Sen University, in Guangzhou, China, and co-authors wrote. “The application of ART in lupus patients remains to be a matter of ongoing debate.
“Worries lie in lupus flares and thrombotic events induced by ovulation induction therapy (OIT), and the uncertainty of pregnancy outcomes hinders the manipulation of ART,” they added. “With the advances in our knowledge and treatment options, however, ART is carried out successfully in lupus patients. It is strongly recommended in women with uncomplicated rheumatic and musculoskeletal diseases whose disease is stable/quiescen.”
To investigate the safety and efficacy of assistive reproductive therapy in patients with lupus, Lao and colleagues conducted a multicenter, observational, retrospective study. The study included patients from three hospitals in Guangzhou who received care between January 2013 and October 2022. Patients with lupus who had unassisted pregnancies during the same time period were assessed as controls in planned and unplanned pregnancy categories.
To be eligible for assistive pregnancy therapy, patients were required to fulfill several criteria, including failing to conceive in a reasonable time period with no use of contraception, no presence of moderate or severe disease flares, no major organ disfunction, taking fewer than 10 mg of prednisone per day and having discontinued immunosuppressive therapy for 6 or more months.
For the purposes of the analysis, assistive therapy included ovarian stimulation, oocyte retrieval, IVF and embryo transfers. Obstetricians performed the ovulation induction therapy procedures for the included patients.
Adverse outcomes were divided into maternal and fetal outcomes. Assessed adverse maternal outcomes included disease flares, pregnancy-induced hypertension, preeclampsia, eclampsia, gestational diabetes mellitus, premature delivery, preterm premature rupture of membranes and fetal loss. Fetal adverse events included in the analysis were intrauterine growth retardation, fetal distress, low-birth weight and very low birth weight.
The analysis included 322 cycles of assistive reproductive therapy across 142 patients. According to the researchers, 66 patients developed 72 clinical pregnancies, resulting in 66 intrauterine pregnancies and six ectopic pregnancies. In all, 65 live infants were born, including five pairs of twins. In all, the clinical pregnancy rate was 46.5%.
According to the researchers, 20 of the 66 patients — or 30.3% — demonstrated primary infertility. Leading causes were obstruction in the fallopian tubes, at 25.8%, and premature ovarian failure, at 13.6%.
In all, 83.3% of pregnancies occurred in patients who received ovulation induction therapy. No ovarian hyperstimulation syndrome or thrombosis was observed in there patients, the researchers wrote.
According to Lao and colleagues, the most common maternal adverse event was premature delivery, at 31.8%; gestational diabetes mellitus, at 22.7%; and disease flares, at 15.2%. There were six cases of fetal loss, which were attributed to “early spontaneous abortion,” the researchers wrote.
Patients who underwent assistive therapy did not appear to have higher rates of adverse events than patients with SLE who experienced planned or unplanned pregnancies, Lao and colleagues reported.
“ART is safe and yields satisfactory outcomes in lupus patients with stable disease for more than one year under close surveillance by a multidisciplinary team,” they wrote. “Maternal and fetal [adverse pregnancy outcomes] are comparable with planned pregnancy and reduced significantly compared with unplanned pregnancy. The incidences of premature delivery, [gestational diabetes mellitus], and [low birth weight] infants, however, are still high.”
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