Page 54 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 3
evaluation, with a strict timing, which is lacking in most studies on LUF syndrome.23 Another explanation of the relation of NSAIDs use with unexplained subfertility may be the effect of pain on sexual intercourse. The use of NSAIDs may indicate that these women experience more pain and therefore they might have less exposure due to a decreased frequency of intercourse. Indeed, sexual intercourse in RA patients is more often limited by pain or fatigue,24 but studies speci cally addressing intercourse frequency in RA patients who try to conceive have not been performed. Furthermore, in daily practice RA patients who are trying to achieve a pregnancy are often very motivated to have regular peri-ovulatory intercourse. However, disease activity was higher in patients who used NSAIDs versus non-users, suggesting that NSAIDs were taken for pain control. All patients using NSAIDs reported that this was because of RA. No patient reported the use of NSAIDs for other conditions.
The percentage of subfertile subjects who received fertility treatments was almost fty percent higher than in the general population.4 Furthermore, the proportion of pregnancies that were conceived with the help of fertility treatments is conform earlier ndings in the PARA study,25 and is also in line with a Danish National Birth Cohort study reporting that more pregnant RA patients compared to pregnant controls had received a fertility treatment.8 The pregnancy rates per treatment cycle and per woman who started treatment were comparable to other subfertile populations as far as intrauterine insemination (IUI) and ovulation induction (OI) were concerned.26 On the contrary, the pregnancy rates of IVF and IVF/ICSI treatments were both higher in RA women.27 Therefore, embryo implantation does not seem to be compromised in RA patients. An explanation for the higher pregnancy rate after IVF or ICSI might be explained by an early start of fertility treatment relative to their previous underexposure to preovulatory sexual intercourse. On the other hand, selection bias may have occurred when women who did not get pregnant after fertility treatments were mainly in the non-participants group. However, since data on the results of fertility treatments in these women were scarcely available, this remains unclear.
One in ve women had stopped trying to conceive because of active disease or anti- rheumatic drugs. In the PARA study, more than one third of the women did not use any anti-rheumatic drugs during the periconceptional period, and less than 5% of the women used biologicals preconceptionally, whereas the disease activity was intermediate or high in the majority of patients.3 Over the last decade, tumor necrosis factor inhibitors have been used increasingly in the periconceptional treatment
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