Infertility history may predict risk for autoimmune rheumatic disease
Key takeaways:
- Women with infertility but no treatment had a higher systemic autoimmune rheumatic disease risk.
- Infertility with noninvasive or invasive treatments did not raise systemic autoimmune rheumatic disease risk.
Women with a history of infertility without fertility treatment were 25% more likely to develop systemic autoimmune rheumatic disease up to 9 years after a naturally conceived childbirth compared with women without infertility, data show.
“Systemic autoimmune rheumatic disease can be tricky to diagnose, often taking years of untreated symptoms and multiple health care visits before a proper diagnosis is made,” Natalie V. Scime, PhD, a Banting postdoctoral fellow at the University of Toronto Scarborough and Institute for Clinical Evaluative Sciences, told Healio. “Early detection is crucial for preventing organ damage, improving treatment outcomes and helping patients maintain the best quality of life.”
Scime and colleagues conducted a population-based study using linked administrative data for all 568,053 singleton births from 465,078 women without known systemic autoimmune rheumatic disease in Ontario, Canada, between 2012 and 2021. Of all women, 88% did not have infertility, 9.2% had infertility without fertility treatment, 1.4% had infertility with noninvasive fertility treatment and 1.4% had infertility with invasive fertility treatment.
Researchers identified systemic autoimmune rheumatic disease based on diagnostic codes at two physician visits, one rheumatologist visit or one hospitalization. Systemic autoimmune rheumatic disease was measured from index to death, loss of health insurance of study end.
The findings were published in Human Reproduction.
During a median follow-up of 6.5 years, per 10,000 person-years, the incident systemic autoimmune rheumatic disease rate was 9.3 for women without infertility, 12.5 for women with infertility and no fertility treatment, 10.9 for women with noninvasive fertility treatment and 10.9 for women with invasive fertility treatment.
Women with infertility and no fertility treatment had a higher risk for systemic autoimmune rheumatic disease, even when accounting for adverse pregnancy outcomes (HR = 1.25; 95% CI, 1.12-1.4). Women with infertility who underwent noninvasive fertility treatments (HR = 1.06; 95% CI, 0.79-1.42) or invasive fertility treatments (HR = 0.97; 95% CI, 0.69-1.36) had no elevated risk for systemic autoimmune rheumatic disease.
According to Scime, the reason why women who received fertility treatments had similar systemic autoimmune rheumatic disease rates as those without may be due to a “healthy patient effect,” in that women who receive treatments may have more privileged backgrounds and be healthier overall, which reduces risk for systemic autoimmune rheumatic disease.
“Our work showed that infertility care presents an opportunity for doctors to carefully screen women for rheumatic symptoms, such as unexplained fatigue, joint pain or skin rashes, and overlapping gynecologic symptoms, such as sexual dysfunction and start a diagnostic workup or rheumatology referral where necessary,” Scime told Healio. “Our study highlights several avenues for future research, such as exploring whether specific causes of infertility are more strongly associated with systemic autoimmune rheumatic disease risk and investigating the potential biological pathways through which the pathophysiology of systemic autoimmune rheumatic disease might impact female fertility.”
For more information:
Natalie V. Scime, PhD, can be reached at natalie.scime@ucalgary.ca; X (Twitter): @NatalieScime.