ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2554

In Vitro Fertilization In Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A Series Of 82 Cycles

Pauline Orquevaux1, Agathe Masseau2, Véronique le Guern3, Vanessa Gayet4, Danièle Vauthier-Brouzes5, Du Boutin6, Bertrand Wechsler7, Nathalie Morel8, Jean Loup Pennaforte1, Jean-Charles Piette9 and Nathalie Costedoat-Chalumeau10, 1Hu Robert Debre, CHU Reims, Reims, France, 2Internal Medicine Department, Nantes University Hospital, Nantes, France, 3Department of Internal Medicine, Hôpital Cochin, Paris, France, 4Cochin Hospital, Paris, France, 5gynecology obstetrical, Pitié Salpétrière Hospital, Paris, France, 6Internal Medicine, Assistance Publique-Hôpitaux de Paris, Hopital Pitié-Salpétrière, Paris, France, 7Internal Medicine, DHU 2iB Internal Medicine Referal Center for Autoimmune diseases Pitie Hospital, Paris, France, 8Internal Medicine, COCHIN, Paris, France, 9Department of Internal Medicine 1., CHU Pitié-Salpêtrière, Paris, France, 10Internal Medicine, Department of Internal Medicine, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Systemic Lupus Erythematosus-Clinical Aspects III: Biomarkers, Quality of Life and Disease Indicators, Late Complications

Session Type: Abstract Submissions (ACR)

Background/Purpose: Patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) undergoing in vitro fertilization (IVF) are at increased risk of both hormone-associated flare and thrombosis. The literature is scarce with two series of IVF performed in 19 and 21 patients respectively [1; 2]. We report our experience with in vitro fertilization in 34 women with SLE and/or APS.

Methods: Retrospective study of women followed in four French centers (Pitié-Salpêtrière, Cochin, Nantes and Reims) who (1) had a diagnosis of SLE (ACR criteria) and/or APS (Sydney criteria), and (2) underwent at least one cycle of IVF between 2003 and 2012.

Results: The diagnosis of the 34 included women was: SLE alone (n=9, including one case diagnosed during the IVF), SLE associated with antiphospholipid antibodies (n=9), SLE associated with APS (n=5), and primary APS (n=11, including one case diagnosed during the IVF).

These women underwent 82 cycles of IVF. Underlying causes of infertility were of female origin (42%), male origin (33%), mixed (21%) or unexplained (4%). There was no premature ovarian insufficiency due to cyclophosphamide.

Median age at IVF was 34.7 years (range, 22-45). Median number of IVF cycles was 2.4 (1-7). 72 cycles (88%) of IVF were allowed and supervised by an internist. Women were treated with hydroxychloroquine (52%), steroids (61%), aspirin (79%) and/or low-molecular-weight heparin (67%). Ovulation induction protocols varied according to the centers.

Eight IVF cycles (10%) resulted in complications: SLE flare in 4 (three joint flares and one lupus enteritis) and thrombosis in 4. Interestingly, one SLE flare occurred in a patient with unknown SLE and 2 flares and 2 thromboses were explained by poor adherence to treatment. No ovarian hyperstimulation syndrome was observed.

24 pregnancies (29%) occurred, including four twin pregnancies, and lead to 22 live births (92% of pregnancies), 1 miscarriage and one medical termination for trisomy 13.

In addition, during the follow-up, eight spontaneous pregnancies occurred. Eventually, a total of 24 patients (70%) delivered at least one healthy child.

Conclusion: SLE flare and thrombosis were low (10%) and were often explained by poor adherence to treatment or absence of treatment. These preliminary results confirm that IVF can be successfully performed in SLE and/or APS women providing they have adequate treatment. The new protocols using GnRH antagonists may further decrease those risks.

[1] Le Thi Huong D et al. Semin Arthritis Rheum 2002 ; 32 : 174-188     

[2] Guballa N et al., Arthritis Rheum 2000 ; 43 : 550-556

Disclosure:

P. Orquevaux,
None;

A. Masseau,
None;

V. le Guern,
None;

V. Gayet,
None;

D. Vauthier-Brouzes,
None;

D. Boutin,
None;

B. Wechsler,
None;

N. Morel,
None;

J. L. Pennaforte,
None;

J. C. Piette,
None;

N. Costedoat-Chalumeau,
None.

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