Page 19 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

The main causes of subfertility in women are anovulation, tubal occlusion, and 1 endometriosis.65-67 Anovulation can have a central cause (hypogonadotropic hypogonadism), or an ovarian cause (such as ovarian failure, or polycystic ovary
syndrome). Tubal occlusion can be bilateral or unilateral.
In up to 30% of subfertile couples, no obvious cause is detected and hence they are referred to as couples with unexplained subfertility.65-67
Fertility in rheumatoid arthritis
In the past sixty years, numerous solitary reports on reproduction in women with RA have been published. The two oldest reports both describe a smaller family size in women with RA68,69, which has been con rmed over time by several studies70-74. Nulliparity is more common in women with RA compared to controls70,75 and a single study has related this to the presence of RF69. When looking at the time to pregnancy (TTP), women with RA had a longer TTP than controls for the rst pregnancy and similarly for consecutive pregnancies either after or before the onset of RA.70 Already before disease onset, a TTP longer than 12 months was found in 42% of RA patients.76 In a group of pregnant RA patients, 25 percent spent more than 12 months before they conceived.77 Moreover, more women with RA received fertility treatments compared to healthy women without RA.78
It has been reported that one in ve women with RA consider their disease in their childbearing decisions. These women had signi cantly fewer pregnancies and fewer children than women who did not consider RA in childbearing decisions.72
Miscarriages in RA
The aim of reproduction is a live born baby after an uneventful pregnancy. Miscarriage, being early pregnancy loss before 16 weeks of gestation, occurs in 10-20% of pregnant women, with a the miscarriage rate increasing with advancing maternal age.79 Reports on miscarriages in RA patients are scant and have produced contradictory results. An increased miscarriage rate has been reported by several authors70,78,80, whereas other studies have found no increase in miscarriage rates in RA patients.69,81-83 When RA patients are exposed to MTX after conception, which is often the case in unplanned pregnancies in this patient group, the incidence of miscarriages is increased.19
General introduction
17