Decreased chance of a live born child in women with rheumatoid arthritis after assisted reproduction treatment: a nationwide cohort study

Abstract

ObjectivesNo studies have examined the efficacy of assisted reproductive technology (ART) treatment in women with rheumatoid arthritis. Therefore, we examined the chance of live birth after ART treatment in women with rheumatoid arthritis compared with women without rheumatoid arthritis.MethodsOur cohort study is based on nationwide Danish health registries, comprising all women with an embryo transfer during 1 January 1994 through 30 June 2017. The cohorts comprised 1149 embryo transfers in women with rheumatoid arthritis, and 198 941 embryo transfers in women without rheumatoid arthritis. Our outcome was live birth per embryo transfer, and we controlled for multiple covariates in the analyses. In subanalyses, we examined a chance of biochemical/clinical pregnancy after ART and a possible impact of corticosteroid use prior to embryo transfer.ResultsThe adjusted OR (aOR) for a live birth per embryo transfer in women with rheumatoid arthritis, relative to women without rheumatoid arthritis, was 0.78 (95% CI 0.65 to 0.92). The aORs for biochemical and clinical pregnancies were 0.81 (95% CI 0.68 to 0.95) and 0.82 (95% CI 0.59 to 1.15), respectively. Corticosteroid prescription prior to embryo transfer increased the OR for live birth (aOR=1.32 (95% CI 0.85 to 2.05)).ConclusionsThe chance of a live birth was significantly reduced in women with rheumatoid arthritis receiving ART treatment, relative to women without rheumatoid arthritis, and our result suggested that the problem was related to an impaired chance of embryo implantation. The role of corticosteroid use prior to embryo transfer must be a subject for further research.

Live-born children after assisted reproduction in women with type 1 diabetes and type 2 diabetes: a nationwide cohort study

“…Findings in women with other autoimmune diseases have suggested a reduced chance of live birth after ART treatment (adjusted OR [95% CI] for a live birth after ART was 0.78 [0.67, 0.91] in women with ulcerative colitis, 0.61 [0.47, 0.79] in women with Crohn’s disease, 0.78 [0.65, 0.92] in women with rheumatoid arthritis and 0.80 [0.69, 0.93] in women with hyperthyroidism) [ 18 – 20 ]. The results of the present study are reassuring for women with type 1 diabetes with an autoimmune aetiology, since the women with type 1 diabetes had the same chance of a positive outcome for ART treatment as women without diabetes.…”

“…Assisted reproductive technology (ART) treatment is a relevant intervention in women who cannot conceive naturally. However, recently published studies have suggested that women with rheumatoid arthritis, Crohn's disease, ulcerative colitis and hyperthyroidism have a decreased chance of producing a live-born child after ART treatment compared with women without these conditions [17][18][19][20]. The studies also indicate that the decreased chance of a live birth might be due to failure to achieve a biochemical pregnancy and not a failure to carry the pregnancy to term.…”

<p>Corticosteroids Prior to Embryo Transfer in Assisted Reproduction in Women with Crohn’s Disease and Ulcerative Colitis – A Nationwide Cohort Study</p>

“…2,8 In former studies we have examined the efficacy of ART treatment in women with Crohn's disease (CD), ulcerative colitis (UC), and rheumatoid arthritis. 9,10 These suggest a reduced chance of a live birth after ART treatment in women with these diseases, compared to other women receiving ART treatment. Our data also indicate that the problem might be related to impaired embryo implantation.…”

“…Our data also indicate that the problem might be related to impaired embryo implantation. [9][10][11] It is possible that increased systemic inflammation in patients with CD, UC and rheumatoid arthritis might affect ART success either via decreased endometrial receptivity or another mechanism. In women with rheumatoid arthritis, we examined the impact of corticosteroids prior to embryo transfer, and although not statistically significant, our data suggested that corticosteroids prescribed before embryo transfer improved the chance of a live birth.…”

“…In women with rheumatoid arthritis, we examined the impact of corticosteroids prior to embryo transfer, and although not statistically significant, our data suggested that corticosteroids prescribed before embryo transfer improved the chance of a live birth. 10 The impact of corticosteroids prior to ART treatment in patients with CD and UC however, has never been studied.…”