Infertility in Systemic Lupus Erythematosus
Infertility in Systemic Lupus Erythematosus
SLE is a multi-system, autoimmune condition that can influence both male and female fertility. Inability to conceive may be attributed to several factors that may act singly or in combination: (i) older age in patients with SLE compared with healthy controls; (ii) disease-related infertility; and (iii) infertility through gonadotoxic treatments. In addition, psychosocial factors related to the disease may lower fecundity and may be associated with apparent infertility. Many therapeutic avenues are open to counteract reproductive damage in the management of SLE and to assist conception once infertility is diagnosed. These treatments can include the administration of gonadotrophin-receptor hormone analogues while receiving CYC treatment, the use of assisted reproductive technologies, such as in vitro fertilization and psychosocial intervention to promote a healthier relationship with their partner. Knowledge of how these reproductive problems occur and its prevention/treatment in SLE patients should avert irreversible infertility as well as give hope to SLE patients with infertility.
SLE is a multisystem, autoimmune disease that has a predilection for women of childbearing age. The reproductive system may be affected in women and men, as a result of disease activity and through iatrogenic cytotoxic treatments. Impairment of reproductive capability can be due to: (i) problems preventing successful fertilization thus leading to infertility; (ii) obstacles in effective implantation to the uterine wall; (iii) difficulties in maintaining pregnancy post-implantation; and (iv) complications during labour. The focus of this review is infertility, which has been defined as the inability for a woman to conceive after 1 year of regular, unprotected coitus. Factors that affect fertility in lupus patients and the management of infertility, including the options for treatment will be discussed.
Abstract and Introduction
Abstract
SLE is a multi-system, autoimmune condition that can influence both male and female fertility. Inability to conceive may be attributed to several factors that may act singly or in combination: (i) older age in patients with SLE compared with healthy controls; (ii) disease-related infertility; and (iii) infertility through gonadotoxic treatments. In addition, psychosocial factors related to the disease may lower fecundity and may be associated with apparent infertility. Many therapeutic avenues are open to counteract reproductive damage in the management of SLE and to assist conception once infertility is diagnosed. These treatments can include the administration of gonadotrophin-receptor hormone analogues while receiving CYC treatment, the use of assisted reproductive technologies, such as in vitro fertilization and psychosocial intervention to promote a healthier relationship with their partner. Knowledge of how these reproductive problems occur and its prevention/treatment in SLE patients should avert irreversible infertility as well as give hope to SLE patients with infertility.
Introduction
SLE is a multisystem, autoimmune disease that has a predilection for women of childbearing age. The reproductive system may be affected in women and men, as a result of disease activity and through iatrogenic cytotoxic treatments. Impairment of reproductive capability can be due to: (i) problems preventing successful fertilization thus leading to infertility; (ii) obstacles in effective implantation to the uterine wall; (iii) difficulties in maintaining pregnancy post-implantation; and (iv) complications during labour. The focus of this review is infertility, which has been defined as the inability for a woman to conceive after 1 year of regular, unprotected coitus. Factors that affect fertility in lupus patients and the management of infertility, including the options for treatment will be discussed.
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