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How Does Lupus Affect Fertility?
The effects that lupus can have on infertility
April 26, 2019
The European League Against Rheumatism (EULAR) has released some recommendations regarding infertility treatments, pregnancy, family planning, and menopause for women who have systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). These guidelines should be helpful to women dealing with these diseases-- as they tend to happen disproportionately more often in women. This is especially crucial news since these conditions also happen when women are reaching their prime fertility years-- or have not yet finished their family planning. In this article we’ll discuss:
What are SLE and APS and how to they affect fertility?
What are EULAR’s recommendations?
What are SLE and APS?
Systemic Lupus Erythematosus (SLE)
SLE is an autoimmune condition where the immune system attacks its own tissues-- causing inflammation and damage in organs. This disease can affect all the major organs-- as well as manifest on the skin in the form of a rash. There is no cure for SLE, but it can be treated with lifestyle adjustments and proper medical attention. It is also managed better the earlier it is caught-- which proves difficult since the signs and symptoms of the disease early on can be mistaken for other conditions.
SLE predominantly affects women-- occurring 10 times more often than in men. It also tends to manifest when women are entering or at their peak of fertility-- in their 20s and 30s. This study wanted to address this-- and offer women some counseling on steps they can take regarding their fertility. They found that because of the age of women when this disease manifests-- it can leave them at a higher risk of infertility and pregnancy complications. Women with this disease are considered a “high risk” pregnancy.
Antiphospholipid Syndrome (APS)
APS is another autoimmune disease that causes the immune system to attack healthy tissue and organs. In this case, the body makes antibodies that mistakenly attack phospholipids. This damages cells-- which in turn cause blood clots in the arteries and veins of a person. This can leave a person with a high risk of deep vein or arterial thrombosis, kidney damage, or pulmonary embolism. Although this disease can affect anyone-- like SLE-- it is more common in women. There is no cure for this condition, although medication is available to prevent blood clots from forming.
Women with APS are also considered to be “high risk” pregnancies. This disease can cause preeclampsia-- which is characterized by high blood pressure and damage to organ systems-- as well as fetal growth restriction and fetal loss. Because this disease is more prevalent in women, it tends to affect them before they have had a chance to have children-- or complete their family. Women with both of these diseases have a better chance at little or no pregnancy complications when they are educated and counseled by doctors-- and that the condition’s symptoms are managed from the outset.
What are EULAR’s recommendations?
The most important recommendation is for SLE and APS patients who are planning-- or currently trying-- to become pregnant is that they are informed of the risks of this decision. They also encourage physicians to create a management checklist from the beginning-- and work with the patient to incorporate a plan that takes into account: the patient’s specific disease activity, serological profile, risk for hypertension, and drug use. They also made additional recommendations including:
SLE and APS women can be made candidates for contraceptive measures based on their disease activity and potential risk
Fertility preservation methods should include gonadotropin releasing hormone prior to considering alkylating agents
Infertility treatments can go ahead as planned, as long as the patient’s disease is stable or inactive. Additional preventative measures will also need to be in place to prevent thrombosis.
Disease activity, serological markers, and renal functions are all good indicators to monitor for potential pregnancy complications in the future-- especially if the disease manifests during pregnancy.
EULAR reviewed a separate study done regarding SLE and amount of pregnancy complications on a Swedish population. They found that women with SLE who had never before had children were at the highest risk of a pregnancy complication. They also hypothesized that SLE can reduce fertility and the chances of a successful pregnancy. This information reinforced the need for women with these conditions to follow EULAR’s recommendations.
It is important for women with these conditions to be aware of theses recommendations-- they should be informed of the risks and their increased chance of complications during a pregnancy. It is reassuring for those with these diseases who may be considering infertility treatment to know that these options are available for them as well-- as long as there are additional preventative measures in place.
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