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[Ovulation induction therapy and systemic lupus erythematosus].
Du Lê Thi Huong1, Bertrand Wechsler, Jean-Charles Piette
1Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris Cedex 13. du.boutin@psl.ap-hop-paris.fr
Annales De Medecine Interne
|May 15, 2003
Summary
Infertility treatments for Systemic Lupus Erythematosus (SLE) patients can trigger disease flares or thrombosis. Careful planning, especially with gonadotropin therapy, is crucial for successful pregnancy outcomes in women with SLE or Antiphospholipid Syndrome (APS).
Area of Science:
- Reproductive Endocrinology
- Rheumatology
- Immunology
Background:
- Systemic Lupus Erythematosus (SLE) prognosis has improved, leading to increased consideration of infertility therapy.
- Fertility in women with SLE is generally normal, except in cases of severe flares, renal insufficiency, or cyclophosphamide-induced ovarian failure.
- Antiphospholipid antibodies are implicated in defective nidation and placental ischemia, potentially impacting fertility and pregnancy.
Purpose of the Study:
- To evaluate the safety and efficacy of infertility treatments in women with SLE and/or Antiphospholipid Syndrome (APS).
- To assess the risks of SLE flare-ups, thrombosis, and pregnancy complications associated with ovulation induction and in vitro fertilization (IVF) protocols.
- To compare outcomes between different ovulation induction agents and IVF strategies.
Main Methods:
- Retrospective analysis of 114 infertility treatment cycles in 21 women with SLE and/or APS.
- Data collection on complications (fetal loss, SLE flare, thrombophlebitis), pregnancy rates, and live-birth rates.
- Comparison of outcomes based on ovulation induction agents (gonadotropins vs. clomiphene) and IVF protocol planning.
Main Results:
- Ovulation induction therapy can unmask underlying SLE or APS, with complications observed in 8 women.
- Pregnancy rates were higher with gonadotropins (25%) than clomiphene (4%). Planned IVF protocols resulted in significantly more live-births (6/7) compared to unplanned protocols (three-quarters of pregnancies led to abortions).
- SLE flare-ups occurred in 13/62 cycles, with higher rates after gonadotropins (27%) and unplanned IVF (30%) compared to clomiphene (6%) and planned IVF (10%). Thrombophlebitis occurred in two women after gonadotropin therapy.
Conclusions:
- Ovulation induction therapy can precipitate SLE or APS, necessitating careful patient selection and monitoring.
- Clomiphene therapy appears to have uncommon complications, while gonadotropin therapy requires consideration of preventive anti-inflammatory measures.
- Planned IVF protocols are associated with better pregnancy outcomes in SLE/APS patients. Prophylactic anticoagulation and anti-inflammatory therapy should be considered for high-risk individuals.