Background/Purpose: Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) often affect women of reproductive age. It remains unclear as to whether these inflammatory rheumatic conditions have an impact on fertility and parity. The aim of our study was to perform a systematic review of the literature to determine if fertility and parity are affected in patients with SLE and RA.

Methods: MEDLINE and EMBASE databases were searched for relevant publications from their inception through to October 2015, using terms including SLE and RA combined with fertility and parity. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MeSH terms such as fertility (fertil*) and pregnancy (pregn*) were included. Two authors screened abstracts to identify eligible articles.

Results: 2,444 articles were identified which consisted of 1,724 and 720 articles from EMBASE and MEDLINE databases respectively. 1,840 duplicated articles were excluded. After exclusion of non-rheumatological conditions, 334 articles remained. 38 papers related to SLE and RA were identified of which 4 papers had both SLE and RA data totalling RA=22 and SLE n=20. A total of 7293 patients, 4406 with RA and 2287 with SLE were included. Articles captured retrospective and prospective case control, cohort and cross-sectional studies ranging from years 1956 to 2015. There was variation in SLE and RA diagnostic criteria used. Exclusion criteria such as other rheumatic diseases such as antiphospholipid syndrome, effects of fertility on disease, assisted reproduction, conference abstracts and non-English papers were applied. In the RA cohort, 5 studies reported no difference in fertility and/or parity. 8 RA studies reported reduced fertility/early menopause and 9 reduced parity/increased pregnancy loss. In the SLE cohort, 5 studies reported no difference in fertility and/or parity. 11 reported reduced fertility/ovarian reserve or menstrual dysfunction affecting fertility and 6 reported reduced parity/pregnancy loss.

Conclusion:  This comprehensive review captured fertility and parity information on 7,293 patients. Limitations of our analysis included heterogeneity of outcome measures, which included ovarian reserve, anti-mullerian hormone (AMH) levels, TTP (time to pregnancy), nulliparity, premature menopause and pregnancy rates. Additionally, potential confounding factors included the effect of disease activity and differences between older and more recent studies. Despite the limitations, the majority of studies showed reduction in fertility and/or parity. Data from multicentre cohorts would be valuable.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-patients-with-systemic-lupus-erythematosus-and-rheumatoid-arthritis-have-reduced-fertility-and-parity-a-systematic-review/