Safety and Efficacy of <i>in Vitro</i> Fertilization in Women with Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Genest, Geneviève; Laskin, Carl A.

doi:10.3899/jrheum.170064

Cited by 7 publications

(3 citation statements)

References 16 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cryopreservation of oocytes and gametes can be undertaken, but this usually requires ovarian stimulation, which will typically delay cyclophosphamide administration and, given the immunomodulatory role of oestrogen believed to underlie the female predominance of lupus, carries a theoretical risk of lupus flare. Published data on the risks of ovarian stimulation are limited, conflicting, and there is an absence of prospective trials [87, 88]. Natural cycle in-vitro fertilization (IVF) negates the need for ovarian stimulation and has been described in six patients with nephritis [89].…”

Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Clinical practice guideline on pregnancy and renal disease

et al. 2019

View full text Add to dashboard Cite

The aim of this guideline is to improve the standard of, and to reduce regional variation in, the care of women with CKD in the UK who are pregnant, planning a pregnancy or post-partum. Scope This guidance covers the care of women with CKD (including renal transplant recipients) who are planning a pregnancy, pregnant, or in the post-partum period. It also covers contraception and fertility for women with CKD. This guideline can be used in the following settings: General practice Community and hospital antenatal clinics Antenatal, labour and postnatal wards Renal outpatients Renal wards Dialysis units The target audience and intended users of this guideline are nephrologists, obstetricians, obstetric physicians, midwives, renal nurses, pharmacists, specialist trainees in both nephrology and obstetrics, and women with CKD who are pregnant or considering pregnancy. Qualitative data on the experience of pregnancy and renal disease is provided in Appendix 1. A summary of clinical responsibility for elements of the guideline is provided in Appendix 2. The clinical issues covered in this guideline are: Structure of care Medication Pre-pregnancy care 3.1.Contraception 3.2.Fertility 3.3.Pre-pregnancy counselling and optimisation for pregnancy Pregnancy care 4.1 Assessment of renal function in pregnancy 4.2 Antenatal care 4.3 Pre-eclampsia prophylaxis 4.4 Blood pressure management 4.5 Thromboembolism prophylaxis 4.6 Anaemia 4.7 Bone health 4.8 Renal biopsy 4.9 Peripartum care 4.10 Postnatal care Pregnancy Care Assessment of renal function in pregnancy Guideline 4.1.1 We recommend renal function in pregnancy is assessed using serum creatinine concentrations as estimated GFR (eGFR) is not valid for use in pregnancy (1C). Guideline 4.1.2 We recommend women with CKD have formal quantification of proteinuria in pregnancy (1D). Guideline 4.1.3 We recommend quantification of proteinuria is undertaken by protein:creatinine ratio (uPCR) or albumin:creatinine ratio (uACR). Twenty-four hour urine collection for quantification of protein is not required (1B). Antenatal care Guideline 4.2.1 We suggest pregnant women with CKD who have not had pre-pregnancy counselling by the MDT are referred to the MDT and receive the same counselling and optimisation as for women attending pre-pregnancy (2D). Guideline 4.2.2 We recommend pregnant women with CKD receive routine antenatal care, in addition to specialist input (1D). Guideline 4.2.3 We recommend pregnant women with CKD be referred for assessment by a consultant obstetrician (1D). Guideline 4.2.4 We recommend pregnant women with CKD have access to usual trisomy screening with specialist interpretation of high-risk results (1C). Guideline 4.2.5 We recommend women with CKD exposed to teratogenic drugs in the first trimester are referred to a specialist fetal medicine unit (1D). Guideline 4.1.6 We recommend pregnant women with CKD have scans to assess fetal growth and wellbeing in the third trimester (1C). Guideline 4.2.7 We recommend pregnant women taking prednisolone and/or calcineurin inhib...

show abstract

Section: Rationale For Clinical Practice Guidelinesmentioning

confidence: 99%

Clinical practice guideline on pregnancy and renal disease

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Given that the female predominance of lupus is hypothesized to be due to the modulation of the immune system by sex hormones, there is a concern that artificial ovarian stimulation in lupus confers a risk of disease exacerbation and thrombosis, especially in the context of circulating antiphospholipid antibodies. Published data on the risks of ovarian stimulation are limited 21 , 22 and conflicting, 22 and there is an absence of prospective trials. Natural cycle oocyte retrieval negates the need for ovarian stimulation and has been described in a small cohort of 7 women with CKD, including 5 women with lupus nephritis.…”

Section: Fertilitymentioning

confidence: 99%

“…Over recent decades, the prognosis for many glomerular diseases has improved. With increasing numbers of women achieving disease quiescence, 21 and social trends of increasing maternal age, 28 the issue of reproductive technology has become increasingly relevant for women with glomerular disease. A recent retrospective study of 97 cycles of in vitro fertilization (IVF) in women with SLE and/or antiphospholipid syndrome showed that IVF was safe and conferred comparable pregnancy outcomes to the general population.…”

Section: Fertilitymentioning

confidence: 99%

Glomerular Disease in Women

Wiles

Lightstone

2018

Kidney International Reports

View full text Add to dashboard Cite

Gender differences exist in the prevalence of glomerular diseases. Data based on histological diagnosis underestimate the prevalence of preeclampsia, which is almost certainly the commonest glomerular disease in the world, and uniquely gender-specific. Glomerular disease affects fertility via disease activity, the therapeutic use of cyclophosphamide, and underlying chronic kidney disease. Techniques to preserve fertility during chemotherapy and risk minimization of artificial reproductive techniques are considered. The risks, benefits, and effectiveness of different contraceptive methods for women with glomerular disease are outlined. Glomerular disease increases the risk of adverse outcomes in pregnancy, including preeclampsia; yet, diagnosis of preeclampsia is complicated by the presence of hypertension and proteinuria that precede pregnancy. The role of renal biopsy in pregnancy is examined, in addition to the use of emerging angiogenic biomarkers. The safety of drugs prescribed for glomerular disease in relation to reproductive health is detailed. The impact of both gender and pregnancy on long-term prognosis is discussed.

show abstract

Assisted reproductive technologies for women with rheumatic AID

Lockshin

2020

Best Practice & Research Clinical Obstetrics & Gynaecol

View full text Add to dashboard Cite

Safety and Efficacy of in Vitro Fertilization in Women with Systemic Lupus Erythematosus and Antiphospholipid Syndrome

Cited by 7 publications

References 16 publications

Clinical practice guideline on pregnancy and renal disease

Clinical practice guideline on pregnancy and renal disease

Glomerular Disease in Women

Assisted reproductive technologies for women with rheumatic AID

Contact Info

Product

Resources

About