Adverse Pregnancy Outcomes in an IVF Patient with Anti-Synthetase Syndrome: Insights From a Rare Case

Anti-synthetase syndrome (ASS) is a rare autoimmune condition characterized by the presence of anti-aminoacyl tRNA synthetase (ARS) antibodies and systemic features such as interstitial lung disease and myositis. Although autoimmune disorders are known to affect fertility, the impact of ASS on assisted reproductive technology (ART) outcomes remains largely unexplored. We present the case of a 36-year-old woman with primary infertility and no prior autoimmune diagnosis. She underwent six in vitro fertilization (IVF) cycles marked by recurrent fertilization failure, cleavage-stage arrest with high fragmentation and poor grading and oocytes exhibiting a waxy zona pellucida (ZP). Her diminished ovarian reserve (DOR) (anti-Müllerian hormone: 0.351 ng/mL; antral follicle count: 5) was documented prior to ART. Following a rare successful embryo transfer, she developed severe ASS at 20 weeks of gestation, characterized by acute interstitial lung disease (ILD), anti-PL-12 antibody positivity, and myositis. These conditions progressed to life-threatening complications, ultimately necessitating pregnancy termination. This case suggests a possible link between ASS and ovarian dysfunction, potentially mediated by autoimmune injury to follicular structures, cytokine dysregulation, or anti-zona pellucida antibody interference. Moreover, pregnancy-associated immune shifts may exacerbate latent autoimmune activity. Screening for anti-synthetase antibodies could be beneficial in patients with unexplained infertility or recurrent ART failure.