Ovulation induction and in vitro fertilization in systemic lupus erythematosus and antiphospholipid syndrome

Abstract

Objective. During ovulation induction (OI), ovarian stimulation is accomplished by hormonal manipulation, which includes administration of gonadotropins, gonadotropin-releasing hormone agonists, folliclestimulating hormone, and luteinizing hormone. In in vitro fertilization (IVF), progesterone is often added. Because of the possibility of hormone-associated flare or thrombosis, patients with systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (primary APS) undergoing OI/IVF are potentially at increased risk. The present study was conducted in order to assess this risk.Methods. Nineteen women who underwent 68 cycles of OI/IVF were studied by interview and retrospective chart review.Results. Four OI/IVF cycles (25%) in SLE patients resulted in increased lupus activity and 2 (13%) in ovarian hyperstimulation syndrome. One patient with primary APS who was given heparin during multiple cycles developed osteopenia. No thrombosis occurred. Pregnancy complications included toxemia, lupus flare, gastrointestinal hemorrhage due to Mallory-Weiss tear, polygestation, and diabetes. Postpartum complications included nephritis flare, costochondritis, and suicidal depression. Lupus flares occurred at expected rates. Five of 16 cycles (31%) in 7 SLE patients, 5 of 48 cycles (10%) in 10 primary APS patients, and 0 of 5 cycles in 2 women with antiphospholipid antibody (without SLE or primary APS) resulted in liveborn children, including multiple gestations (3 twin sets with 4 surviving infants and 2 triplet sets with 3 surviving infants). Seven of 14 living children (50%) were premature, 3 had neonatal lupus, and 1 had pulmonic stenosis. Five surviving infants (38%) had complications unrelated to prematurity.Conclusion. Although OI/IVF can be successful in SLE and primary APS patients, rates of fetal and maternal complications are high.

Severe Thromboembolism and Systemic Lupus Erythematosus Developing after Ovarian Hyperstimulation in a Persistent Carrier of Antiphospholipid Antibodies

“…Vascular occlusions following OH have not been described in PAPS [6], but for a case of cerebral infarction developed in a PAPS patient with an obstetric history [7]; on the other hand intra-cardiac occlusion [8], ischaemic strokes [9,10] and catastrophic APS [11] have been described in carriers of aPL who had never suffered thrombosis. With regards to the development of SLE after PAPS, this has been detailed in two reviews over the last 12 years but OH was not involved in any of the progressions from PAPS towards SLE [12,13].…”

Ovarian stimulation and embryo banking for fertility preservation in a woman with severe mixed connective tissue disease: is it safe?

“…Increased lupus activity or OHSS were diagnosed in 43% and 29% of SLE patients, respectively, and were generally mild. No adverse events were reported in any woman with primary APS [12]. The second study included women with SLE or APS undergoing a total of 114 OI or IVF cycles.…”

The Pathophysiology of Antiphospholipid Syndrome

“…This ratio was higher in patients with SLE (7:1) than in primary APS (3,5:1) (p< 0,005) [91]. However, in an American retrospective studio with non-SLE associated APS in which patients received ovarian stimulation, there were no reports of thrombosis or maternal complications [92]. Studies to improve knowledge of hormonal influence are in progress.…”