Women with RA should expect a reduced success rate after assisted reproduction
medwireNews: Women with rheumatoid arthritis (RA) have a significantly lower chance of having a live birth following assisted reproductive technology (ART) treatment than women without RA, researchers report in the Annals of the Rheumatic Diseases.
The study included data for 354 women with RA who underwent 1149 ART treatments and 66,913 women without RA who underwent 198,941 ART treatments in Denmark over a 23.5-year period.
ART treatments included in vitro fertilization, with or without fertilization with intracytoplasmic sperm injection, and transfer of frozen-thawed embryos.
After adjustment for several potential confounders including the type of ART treatment used and cause of infertility, the researchers found that women with RA had a significant 22% lower likelihood for a live birth per embryo transfer than women without RA, at rates of 18.1% versus 23.7%.
Compared with women who did not have RA, those with RA were also a significant 19% less likely to have a biochemical pregnancy, defined as a positive human chorionic gonadotropin result at 14–16 days after embryo transfer, and a non-significant 18% less likely to have a clinical pregnancy, defined as a pregnancy detected by ultrasound examination 7–8 weeks after embryo transfer.
These results indicate that “the reason for a decreased chance of live birth was related to decreased chance of implantation of the embryo,” Bente Mertz Nørgård (Odense University Hospital, Denmark) and co-investigators remark.
Nørgård and team also examined the impact of prescription corticosteroid use in the 3 months prior to embryo transfer and found that women with RA who had used corticosteroids during this period were 1.32 times more likely to have a live birth than those who had not, at rates of 19.7% and 17.6%, respectively.
The improved odds of a live birth increased further, to 1.83-fold, when the time period for corticosteroid use was restricted to 1 month prior to embryo transfer.
The study authors say their findings indicate, for the first time, that women with RA undergoing ART treatment “cannot expect the same success per embryo transfer as other women seeking ART.”
However, they also stress that the study does not “reveal whether the decreased chance of live birth per embryo transfer in women with RA is related to the disease itself or to factors closely related to RA.”
And although Nørgård et al believe that further studies are needed “to examine the role of corticosteroids prior to embryo transfer in women with autoimmune diseases,” they conclude that their results “should be considered when planning the offered number of ART treatment cycles in women with rheumatoid arthritis, and when preparing clinical guidelines for ART treatments.”
By Laura Cowen
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