Page 88 - Fertility in Women with Rheumatoid Arthritis Vruchtbaarheid van vrouwen met reumatoïde artritis

Chapter 6
in assisted reproductive technology cycles, 19-22 and low serum AMH levels have been described to be associated with a reduced chance of natural conception,23 although conflicting results have been reported.24
To study the ovarian reserve in women with RA, we measured serum AMH levels in women with RA who had participated preconceptionally in a nationwide cohort study, and we studied the association of preconceptional AMH levels with subfertility in these women, as measured by TTP.
METHODS
Patients
A post-hoc analysis was performed within the Pregnancy-induced Amelioration of RA (PARA) study, a nationwide prospective cohort from 2002-2010 from the Netherlands. Patients were recruited in 2002-2008 by their attending rheumatologist, when they had a diagnosis of RA according to the American College of Rheumatology (ACR) 1987 classi cation criteria25 and were trying to conceive or were in their rst trimester of pregnancy. Patients had to have a good understanding of the Dutch language.26 The PARA study was approved by the Medical Ethics Research Committee of the Erasmus MC, university medical center Rotterdam.
For the current study, only those patients were included in the analysis who were assessed during the preconceptional period. In patients who participated twice or more in the PARA study, only the rst occurring preconceptional visit was selected.
Data collection
During the PARA study, patients were visited at their homes by a member of the research team. Assessments took place before conception (when possible), during each trimester of pregnancy, and 6, 12 and 26 weeks after delivery. At every visit, patients lled out questionnaires on obstetric history, medication use, health and daily functioning. Disease activity was measured, and a blood sample was drawn.26 All data was collected in the PARA database. Variables used for analysis were: date of start trying to conceive, age at start trying to conceive, age at drawing of serum sample, duration of disease, occurrence of any previous pregnancies, presence of rheumatoid factor (RF), presence of anti-citrullinated protein antibodies (ACPA), preconceptional disease activity, patient-reported erosions, preconceptional use of
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