Page 44 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 3
ABSTRACT
Objective: Subfertility is frequently encountered amongst female rheumatoid arthritis (RA) patients and has been associated with disease activity and anti- rheumatic drugs. However, little is known about the results of the fertility work-up in these women. Our aim was to study the outcome of fertility assessments in subfertile women with RA.
Methods: A cross-sectional study was performed in a nationwide cohort of female RA patients who were pregnant or were trying to conceive between 2002 and 2010 (PARA study). Patients who had given consent for future contact (n=260) received a questionnaire on reproductive history, fertility work-up and fertility treatments. Medical les were obtained from attending gynaecologists.
Results: A completed questionnaire was returned by 178 women (68%), of whom 96% had ended their efforts to conceive. Eighty-two subjects (46%) had at least one subfertile episode, and for 61 women a diagnosis for subfertility was available. Unexplained subfertility (48%) and anovulation (28%) were the most common gynaecological diagnoses, and both occurred more often in RA patients than reported in the general population. Women with unexplained subfertility more often used NSAIDs during the periconceptional period. Seventeen percent of all pregnancies were conceived after fertility treatments. Fertility treatments had equal or higher pregnancy rates in RA compared to other subfertile populations.
Conclusion: Unexplained subfertility is more often diagnosed in subfertile female RA patients than in the general population, and is related to periconceptional NSAIDs use. Despite the higher incidence of subfertility in women with RA, the outcome of fertility treatments in these women appears favourable.
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