Page 45 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

INTRODUCTION
Fertility is compromised in women with rheumatoid arthritis (RA). They often have
fewer children than they intended to have and they are more often nulliparous.1,2
In 36-42% of female RA patients, diagnosed before family completion, the time to
pregnancy (TTP) exceeds twelve months,1,3 whereas in the general population, this is
only the case in 10-17% of couples.4-6 Since in most women with RA anti-rheumatic
treatment has to be adjusted before they start trying to conceive, a longer TTP can 3 result in a prolonged period with less adequately controlled disease and consequently
an increased risk for permanent damage to the joints. Hence, understanding the underlying mechanisms of subfertility in RA, and treatment of these mechanisms whenever possible, would be an important step forward in the care for these patients. Fertility in a couple might be compromised by many different factors, in the male as well as in the female partner. Male factors for subfertility include disorders in spermatogenesis or obstructions – causing oligospermia or azoospermia – and ejaculatory dysfunction. Female causes include anovulation, unilateral or bilateral tubal occlusion, and endometriosis. In 8-28% of subfertile couples no speci c cause is found during fertility assessments. They are generally referred to as couples with unexplained subfertility.5,7
In most studies on fertility in RA, gynaecological data are missing. It has been reported that pregnant women with RA more often had a fertility treatment than pregnant controls.8 However, little is known on the outcome of fertility assessments, and details on subfertility diagnoses have not been reported.
To study the outcome of fertility assessments in women with RA who suffer from subfertility, we performed a cross-sectional study in female RA patients from the Pregnancy-induced Amelioration of RA (PARA) cohort.
PATIENTS AND METHODS
Patients
Patients from the PARA study were invited to participate. The PARA study was a nationwide prospective observational cohort in the Netherlands (2002-2010) which included women with RA (1987 revised ACR criteria9) who were trying to conceive or were in their rst trimester of pregnancy. PARA participants had to have a good understanding of the Dutch language and were allowed to participate more than
Fertility in RA – fertility assessments
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