Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jun 14:15:1412174.
doi: 10.3389/fimmu.2024.1412174. eCollection 2024.

Fertility issues in women of childbearing age with spondyloarthritis

Sara Bindoli  1 , Giacomo Cozzi  1 , Mariagrazia Lorenzin  1 , Paolo Sfriso  1 , Andrea Doria  1 , Laura Scagnellato  1 , Roberta Ramonda  1
Affiliations
Review

Fertility issues in women of childbearing age with spondyloarthritis

Sara Bindoli et al. Front Immunol. .

Abstract

The topic of fertility in women with spondyloarthritis (SpA) has been scarcely investigated to date. Recent systematic reviews and registry studies have brought renewed attention to the plight of women of childbearing age with rheumatic diseases, in particular SpA. Fertility may be impacted by physical impairment, hormonal imbalances and psychological distress. Several studies observed a reduction in anti-Müllerian hormone in women with SpA, reflecting a reduced ovarian reserve (OR). Furthermore, disease activity and the use of certain therapies can alter fertility, and this is reflected in a prolonged time-to-pregnancy (TTP), a validated outcome measure that can evaluate the status of subfertility. The employment of glucocorticoids or non-steroidal anti-inflammatory drugs has also been linked to reduced fertility, whereas the use of biologics, especially tumour necrosis factor inhibitors (TNFi), is not associated with a prolonged TTP. In all women of childbearing age with rheumatic diseases, preconception counselling is paramount, and a referral to a reproductive specialist should be considered in the presence of multiple factors that may influence fertility. A comprehensive evaluation involving a multidisciplinary team of rheumatologists, gynaecologists, and often psychologists is warranted. In this narrative review, we collected the currently available literature focusing on fertility issues in women affected by SpA, providing data on fertility outcomes, hormonal imbalance, and therapeutic concerns.

Keywords: bDMARD; fertility; hormones; pregnancy outcome; psychological distress; spondyloarthritis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Factors that may influence pregnancy desire and fertility in women with Spondyloarthritis. AFC, antral follicle count; AMH, anti-Müllerian hormone; b, biological; csDMARDs, conventional synthetic Disease modifying antirheumatic drugs; FSH, follicle stimulating hormone; IBD, intestinal bowel disease; LH, luteinizing hormone; NSAIDs, non-steroidal anti-inflammatory drugs; TNF, Tumor Necrosis Factor.
Figure 2
Figure 2
PRISMA flowchart.
See this image and copyright information in PMC

References

    1. Østensen M, Andreoli L, Brucato A, Cetin I, Chambers C, Clowse MEB, et al. . State of the art: Reproduction and pregnancy in rheumatic diseases. Autoimmun Rev. (2015) 14:376–86. doi: 10.1016/j.autrev.2014.12.011 - DOI - PubMed
    1. Andreoli L, Chighizola CB, Iaccarino L, Botta A, Gerosa M, Ramoni V, et al. . Immunology of pregnancy and reproductive health in autoimmune rheumatic diseases. Update from the 11th International Conference on Reproduction, Pregnancy and Rheumatic Diseases. Autoimmun Rev. (2023) 22:103259. doi: 10.1016/j.autrev.2022.103259 - DOI - PubMed
    1. Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KA, Nordvag B-Y, Koldingsnes W, et al. . Fertility in women with chronic inflammatory arthritides. Rheumatology. (2011) 50:1162–7. doi: 10.1093/rheumatology/keq458 - DOI - PubMed
    1. Østensen M. Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol. (2017) 13:485–93. doi: 10.1038/nrrheum.2017.102 - DOI - PubMed
    1. Clowse MEB, Chakravarty E, Costenbader KH, Chambers C, Michaud K. Effects of infertility, pregnancy loss, and patient concerns on family size of women with rheumatoid arthritis and systemic lupus erythematosus. Arthritis Care Res (Hoboken). (2012) 64:668–74. doi: 10.1002/acr.21593 - DOI - PubMed