Maintenance of fertility in patients with rheumatic diseases needing antiinflammatory and immunosuppressive drugs

Silva, Clóvis A.; Bonfá, Eloísa; Østensen, Monika

doi:10.1002/acr.20323

Cited by 70 publications

(64 citation statements)

References 78 publications

(183 reference statements)

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“…Moreover, as recent studies have reported that decreased AMH levels can be observed in women using hormonal contraceptives [17,18], the ovarian hormonal profile described herein was determined without the effect of any exogenous hormone for a period of at least 6 months to avoid this possible bias.…”

Section: Discussionmentioning

confidence: 99%

Reduced ovarian reserve in patients with adult polymyositis

et al. 2015

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Polymyositis (PM) affects female gender during reproductive age; however, there is no study assessing ovarian reserve in these patients to evaluate ovarian reserve markers in PM. Eight female patients with PM (Bohan and Peter criteria, 1975) with aged 18-40 years, followed at our tertiary centre from March 2011 to May 2014, were invited to participate. They were age-matched with 16 healthy individuals (control group). All were evaluated at early follicular phase of menstrual cycle. Follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Müllerian hormone (AMH) serum levels (ELISA) and sonographic antral follicle count (AFC) were determined. PM patients and controls had comparable mean age (31.4 ± 6.5 vs. 30.7 ± 6.2 years, P = 0.946), ethnicity and socioeconomic class (P > 0.05). PM mean age of onset was 27.3 ± 6.5 years and disease duration of 6.5 ± 4.1 years. Menstrual cycles were alike in both groups with a similar frequency of age at menarche, gynaecological age, duration and length of menstrual cycle (P > 0.05). The median serum level of AMH was significantly lower in PM compared to controls [0.7(0.3-3.4) vs. 3.1(1.4-4.0), P = 0.021]. AMH levels ≤1 ng/mL (50 vs. 6.3 %, P = 0.024) and very low AFC (37.5 vs. 6.3 %, P = 0.037) were significantly in PM patients versus controls. The other hormones (FSH, inhibin B and estradiol levels) were similar between both groups (P > 0.05). The present study was the first to identify subclinical ovarian dysfunction in PM patients during reproductive ages. Further study is necessary to assess the possible role of PM-related factors that may influence the ovarian function of these patients.

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Section: Discussionmentioning

confidence: 99%

Reduced ovarian reserve in patients with adult polymyositis

et al. 2015

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“…A study conducted in patients with RA confirmed that the decision to limit the number of children resulted from the anxiety about own disability, particularly when previously an exacerbation of the disease occurred after labour [3]. The data from patients with ankylosing spondylitis (AS) and juvenile idiopathic arthritis (JIA) demonstrated that the decision to conceive was taken later than in healthy subjects [1,2,4].…”

Section: Introductionmentioning

confidence: 87%

“…The diseases thus affect patients at reproductive age. The results of population studies have demonstrated that these diseases can exert effects on the fertility of the patients, family planning, course of pregnancy and further development of the baby [1][2][3][4]. The incidence of infertility in patients with rheumatoid arthritis (RA) is twice as high as in the general population [5].…”

Section: Introductionmentioning

confidence: 99%

“…The incidence of infertility in patients with rheumatoid arthritis (RA) is twice as high as in the general population [5]. The causes of that phenomenon include the effect of immunological factors [interleukin 6, tumour necrosis factor (TNF), regulatory T-cells], pharmacotherapy [effect of non-steroidal anti-inflammatory drugs (NSAIDs), sulfasalazine on the gametes, gonadotoxicity of alkylating drugs; feto-and embryotoxicity of methotrexate, leflunomide, mycophenolate mofetil; necessity of maintenance of breaks in conception during treatment with drugs contraindicated in pregnancy], hormonal disorders (of the hypothalamus-gonads axis) in the course of chronic inflammatory disease, higher risk of loss of pregnancy and complications of its course, and the fact that the patient is aware of that risk [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fertility, pregnancy planning, and pharmacotherapy during the pregnancy, postpartum and breastfeeding period in patients with rheumatoid arthritis and other inflammatory arthropathies

Olesińska¹,

Ostanek²,

Majdan³

et al. 2014

Reumatologia

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Szczyt zachorowań w przypadku większości zapalnych chorób stawów (ZChS) przypada na 2.–4. dekadę życia, a więc dotyczy osób w wieku reprodukcyjnym. Wyniki badań populacyjnych wskazują, że choroby te mogą wywierać wpływ zarówno na płodność pacjentów, planowanie rodziny, przebieg ciąży, jak i dalszy rozwój dziecka. Wykazano także, że kobiety chore na ZChS w porównaniu ze zdrowymi kobietami rzadziej i później decydują się na pierwsze i następne dziecko, a odstęp między kolejnymi ciążami jest dłuższy. Celem farmakoterapii u kobiety z ZChS, która planuje ciążę, jest skuteczne zahamowanie aktywności zapalnej oraz utrzymanie remisji lub małej aktywności choroby w czasie ciąży i po jej zakończeniu. Odpowiednie do stosowania w okresie prekoncepcji i ciąży są następujące leki modyfikujące przebieg choroby: chlorochina, hydroksychlorochina, sulfasalazyna, azatiopryna, cyklosporyna A, glikokortykosteroidy oraz niesteroidowe leki przeciwzapalne. Spośród syntetycznych leków modyfikujących przebieg choroby nie należy stosować: metotreksatu, leflunomidu, cyklofosfamidu oraz mykofenolanu mofetylu, a z leków biologicznych: abataceptu, tocilizumabu i rytuksymabu.

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“…The mechanism of action involves the transfer of alkyl groups to cellular constituents and reaction with DNA bases, which damages DNA repair mechanisms and ultimately results in cell death [16,17]. The mechanism of the effect on fertility, however, remains unknown [17].…”

Section: Dosing Recommendations For Treatment With Cpomentioning

confidence: 99%

Fertility preservation in patients receiving cyclophosphamide therapy for renal disease

et al. 2014

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Cyclophosphamide continues to have an important role in the treatment of renal disease, including nephrotic syndrome and lupus nephritis, despite known complications of gonadotoxicity and potential infertility in both male and female patients. It is important that the physician recommending this therapy mitigates the effect of the drug on fertility by adhering to recommendations on dosing limits and offering fertility-preserving strategies. In addition to wellestablished methods, such as sperm banking and embryo cryopreservation, advances in reproductive technology have yielded strategies such as oocyte cryopreservation, resulting in more fertility-preserving options for the pediatric patient. Despite these advances, there continues to be a significant barrier to referral and access to sperm banks and fertility specialists. These issues are further complicated by ethical issues associated with the treatment of pediatric patients. In this review we explore the development of recommended dosing limits and include a discussion of the available fertility-preserving methods, strategies for increasing access to fertility specialists, and the ethical considerations facing the pediatric healthcare provider.

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Maintenance of fertility in patients with rheumatic diseases needing antiinflammatory and immunosuppressive drugs

Cited by 70 publications

References 78 publications

Reduced ovarian reserve in patients with adult polymyositis

Reduced ovarian reserve in patients with adult polymyositis

Fertility, pregnancy planning, and pharmacotherapy during the pregnancy, postpartum and breastfeeding period in patients with rheumatoid arthritis and other inflammatory arthropathies

Fertility preservation in patients receiving cyclophosphamide therapy for renal disease

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