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.
 Le Thi Huong D et al. Semin Arthritis Rheum 2002 ; 32 : 174-188
 Guballa N et al., Arthritis Rheum 2000 ; 43 : 550-556
V. le Guern,
J. L. Pennaforte,
J. C. Piette,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/in-vitro-fertilization-in-systemic-lupus-erythematosus-and-antiphospholipid-syndrome-a-series-of-82-cycles/