The Efficacy of Assisted Reproduction in Women with a Wide Spectrum of Chronic Diseases – A Review

Abstract

Assisted reproductive technology (ART) treatments in women with underlying chronic diseases have become increasingly frequent. The objective of this review is to provide an overview of the literature examining the chance of having a live born child after ART in women with chronic diseases, compared to other women receiving ART. We focused on some of the most prevalent chronic diseases in women during their reproductive years, ie ulcerative colitis, Crohn’s disease, rheumatoid arthritis, multiple sclerosis, epilepsy, hyperthyroidism, hypothyroidism, and diabetes mellitus. Secondly, we studied the chance of successful implantation. The literature search was performed in the database Pubmed.gov. including all studies published before October 2020. Title and abstracts of 58 papers were reviewed, 37 papers were excluded and other 8 studies were excluded after full-text evaluation. Only 13 papers were eligible for review. Results indicate that women with ulcerative colitis, Crohn’s disease, rheumatoid arthritis, hyperthyroidism, and diabetes mellitus type 2 might have problems with low implantation rate or early embryo development during ART. On the contrary, the few studies on women with hypothyroidism, diabetes mellitus type 1, and epilepsy suggest an equivalent chance of a live birth compared to other women undergoing ART. A possible explanation behind these differences could reside in the disease-specific dysregulation of the innate or adaptive immune system. To our knowledge, this is the first review on ART in women with chronic diseases, and it has disclosed that the evidence in this area is indeed sparse. We encourage others to examine live birth after ART in women with chronic diseases.

The Positive Assistance of Assisted Reproductive Technology

“…A metanalysis of 13 papers looking at ART in people with chronic illness, with several papers considering people with epilepsy (PWE), suggested people with chronic illness had an equivalent chance of a live birth compared to those without a chronic disease. 2 Another study showed that the chance of a live birth per embryo transfer was similar in people with and without epilepsy, demonstrating the efficacy of infertility treatment in PWE. Thus, PWE seeking fertility therapy should be reassured that several studies have demonstrated that anti-seizure medications (ASMs) use during ART treatment did not significantly affect the chances of live birth after embryo transfer nor was there a difference in time to pregnancy.…”