Page 52 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 3
of these women all conceptions were with the help of fertility treatments. Thirteen of the 20 women (65%) who started an in vitro fertilization (IVF) treatment had had intra-uterine inseminations (IUIs) before. Treatments not reported in the table are intravaginal insemination (1 subject), oocyte donation (1 subject), and sperm donation (2 subjects).
Table 2 – Fertility diagnoses in subfertile RA patients from the PARA study
Diagnosis
Unexplained subfertility‡ Anovulation*/**
Male factor* Endometriosis
Tubal occlusion* Vaginismus
Diagnosis by gynaecologist (n=61)
% of subjects
Including self- reported diagnoses (n=71)
Reference population
Hull(5) Thonneau(7)
N
N
% of subjects
%
33
of subjects
12%
32% 26% 58% 6% 4% 14% 26%
NA NA
29
17 28% 20 28% 21%
48%
46%
31%
10 16% 10 14% 4 6.6% 5 7.0% 2 3.3% 4 5.6% 2 3.3% 2 2.8%
* In 2 couples there was both anovulation and a male factor. In 1 couple there was both tubal occlusion and a male factor. ** In 2 women anovulation was due to premature ovarian insuf ciency (POI).
‡ Unexplained subfertility includes a diagnosis of cervical hostility
Table 3 – Fertility treatment results in female rheumatoid arthritis patients from the PARA study
Treatment Subjects
(n=55)*
N of treatments
Resulted in pregnancy
Pregnancy rate
sum
range
missing for n subjects
subjects (n=38)†
pregnancies (n=64) †
per cycle
per woman§
IUI** 36
OI 17
IVF 20
ICSI 8 25 (1-6) - 8 15 60% 100%
IUI = intra-uterine insemination. OI=ovulation induction (with either clomiphene citrate or follicle stimulating hormone injections). IVF = in vitro fertilization. ICSI = intra-cytoplasmic sperm injection.
* 18 women had 2 types of treatments, 4 women underwent 3 different types of treatment.
† 1 women achieved a rst pregnancy after IUI, and a second pregnancy after IVF. 1 woman conceived twice after IUI combined with OI.
§ Percentage women with at least one pregnancy of total number of women who started treatment.
** In 10 women IUI was combined with mild ovarian hyperstimulation (MOH). 9 pregnancies were after IUI with MOH.
178
77 (1-12) 42 (1-4)
3 3 1
12 10 10
19 15 17
(1-11)
11% 19% 40%
33% 59% 50%
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