Page 46 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 3
once. Both the PARA study and this follow-up study were approved by the Erasmus MC medical ethical review board. Of the 297 patients in the PARA cohort, 290 women gave permission to be contacted for future research. For 30 of them no current address was known.
For comparison of the occurrence of different subfertility diagnoses in women with RA to the general population, the incidence of these diagnoses in two reference populations with subfertility are reported.5,7
Data collection
Eligible patients received a printed questionnaire accompanied by a postage paid return envelope. Questionnaires included questions on their reproductive history, TTP in months and mode of conception for each pregnancy, visits to a gynaecologist, fertility assessments and fertility treatments.
When patients consented, data on fertility assessments were collected from the previously attended gynaecologists. The received les and letters were checked for menstrual cycle length, cycle irregularities and their classi cation (according to the World Health Organization (WHO) classi cation10), measurements of follicle stimulating hormone, oestrogens and progesterone, presence of ovulation, history of pelvic inflammatory disease, tests for tubal function (hysterosalpingography, laparoscopy), presence of endometriosis, abdominal adhesions and sperm analysis. The diagnosis was recorded. Furthermore, data on performed fertility treatments and their results were collected. When not all required data could be extracted from the received information, another letter was sent to the gynaecologist requesting explicitly for the missing items. In cases where the fertility work-up was not reported in full detail in the information received, we registered the diagnostic conclusion reported by the gynaecologist, assuming the work-up was performed according to the general consensus, as described in the national guideline by the Dutch Society for Obstetrics and Gynaecology (NVOG).11 These guideline describes that in all couples consulting a gynaecologist for subfertility a fertility work-up includes at least: excluding anovulation by measuring a mid-luteal serum progesterone, assessing the male’s fertility by performing a sperm analysis, and establishing Fallopian tube patency either by doing a Chlamydia antibody screening or by performing a laparoscopy or a hysterosalpingogram.
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