In Vitro Fertilization in 37 Women with Systemic Lupus Erythematosus or Antiphospholipid Syndrome: A Series of 97 Procedures

Pauline Orquevaux; Agathe Masseau; Véronique Le Guern; Vanessa Gayet; Danièle Vauthier; Gaelle Guettrot-Imbert; Du Le Thi Huong; Bertrand Wechsler; Nathalie Morel; Patrice Cacoub; Jean-Loup Pennaforte; Jean-Charles Piette; Nathalie Costedoat-Chalumeau

doi:10.3899/jrheum.160462

In Vitro Fertilization in 37 Women with Systemic Lupus Erythematosus or Antiphospholipid Syndrome: A Series of 97 Procedures

J Rheumatol. 2017 May;44(5):613-618. doi: 10.3899/jrheum.160462. Epub 2017 Jan 15.

Authors

Pauline Orquevaux^{1

2}, Agathe Masseau^{1

2}, Véronique Le Guern^{1

2}, Vanessa Gayet^{1

2}, Danièle Vauthier^{1

2}, Gaelle Guettrot-Imbert^{1

2}, Du Le Thi Huong^{1

2}, Bertrand Wechsler^{1

2}, Nathalie Morel^{1

2}, Patrice Cacoub^{1

2}, Jean-Loup Pennaforte^{1

2}, Jean-Charles Piette^{1

2}, Nathalie Costedoat-Chalumeau^{3

4}

Affiliations

¹ From the Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU), Reims Cedex; Service de médecine interne, CHU, Nantes; Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; Service de gynécologie-obstétrique, Hôpital Cochin, AP-HP; Service de gynécologie-obstétrique, Groupe Hospitalier Pitié Salpêtrière, AP-HP; Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); INSERM, UMR_S 959, F-75013; CNRS, FRE3632, F-75005; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
² P. Orquevaux, MD, Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, CHU; A. Masseau, MD, Service de médecine interne, CHU; V. Le Guern, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; V. Gayet, MD, Service de gynécologie-obstétrique, Hôpital Cochin, AP-HP; D. Vauthier, MD, Service de gynécologie-obstétrique, Groupe Hospitalier Pitié Salpêtrière, AP-HP; G. Guettrot-Imbert, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; D.L. Huong, MD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; B. Wechsler, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; N. Morel, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; P. Cacoub, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; J.L. Pennaforte, MD, PhD, Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, CHU; J.C. Piette, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; N. Costedoat-Chalumeau, MD, PhD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP.
³ From the Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, Centre Hospitalier Universitaire (CHU), Reims Cedex; Service de médecine interne, CHU, Nantes; Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; Service de gynécologie-obstétrique, Hôpital Cochin, AP-HP; Service de gynécologie-obstétrique, Groupe Hospitalier Pitié Salpêtrière, AP-HP; Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B); INSERM, UMR_S 959, F-75013; CNRS, FRE3632, F-75005; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France. nathalie.costedoat@gmail.com.
⁴ P. Orquevaux, MD, Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, CHU; A. Masseau, MD, Service de médecine interne, CHU; V. Le Guern, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; V. Gayet, MD, Service de gynécologie-obstétrique, Hôpital Cochin, AP-HP; D. Vauthier, MD, Service de gynécologie-obstétrique, Groupe Hospitalier Pitié Salpêtrière, AP-HP; G. Guettrot-Imbert, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; D.L. Huong, MD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; B. Wechsler, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; N. Morel, MD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP; P. Cacoub, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; J.L. Pennaforte, MD, PhD, Centre de compétence de maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Robert Debré, CHU; J.C. Piette, MD, PhD, Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), and INSERM, UMR_S 959, F-75013, and CNRS, FRE3632, F-75005, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology; N. Costedoat-Chalumeau, MD, PhD, Université René Descartes Paris V, Centre de référence maladies auto-immunes et systémiques rares, Service de médecine interne, Hôpital Cochin, AP-HP. nathalie.costedoat@gmail.com.

PMID: 28089975
DOI: 10.3899/jrheum.160462

Abstract

Objective: To compile and assess data about complication and success rates for in vitro fertilization (IVF) of women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). To date, such data are sparse.

Methods: This retrospective study described women with SLE and/or APS who have had at least 1 IVF cycle.

Results: Thirty-seven women with SLE (n = 23, including 8 with antiphospholipid antibodies), SLE with APS (n = 4), or primary APS (n = 10) underwent 97 IVF procedures. For 43% of cases, the infertility was female in origin, for 19% male, 14% mixed, and 24% unexplained. No women had premature ovarian insufficiency because of cyclophosphamide. Median age at IVF was 34 years (range 26-46). The median number of IVF cycles was 2.6 (1-8). Patients were treated with hydroxychloroquine (72%), steroids (70%), azathioprine (3%), aspirin (92%), and/or low molecular weight heparin (62%). There were 27 (28%) pregnancies, 23 live births among 26 neonates (3 twin pregnancies), 2 miscarriages, and 2 terminations for trisomy 13 and 21. Six spontaneous pregnancies occurred during the followup. Finally, 26 women (70%) delivered at least 1 healthy child. Complications occurred in or after 8 IVF cycles (8%): SLE flares in 4 (polyarthritis in 3 and lupus enteritis in 1) and thromboembolic events in 4 others. One SLE flare was the first sign of previously undiagnosed SLE. Poor treatment adherence was obvious in 2 other flares and 2 thromboses. No ovarian hyperstimulation syndrome was reported.

Conclusion: These preliminary results confirm that IVF can be safely and successfully performed in women with SLE and/or APS.

Keywords: ANTIPHOSPHOLIPID SYNDROME; ASSISTED REPRODUCTIVE TECHNOLOGY; IN VITRO FERTILIZATION; INFERTILITY; PREGNANCY; SYSTEMIC LUPUS ERYTHEMATOSUS.

MeSH terms

Adult
Antiphospholipid Syndrome / complications*
Female
Fertilization in Vitro*
Humans
Infant, Newborn
Infertility, Female / complications
Infertility, Female / therapy*
Lupus Erythematosus, Systemic / complications*
Male
Middle Aged
Pregnancy
Pregnancy Outcome
Pregnancy Rate
Retrospective Studies