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Lupus and In Vitro Fertilization

While many women with lupus successfully use in vitro fertilization to conceive, it can be risky for some. Read more about these risks and how to prepare for a safe pregnancy!


Introduction to Lupus and In Vitro Fertilization (IVF)

In vitro fertilization (IVF) has provided opportunities for many to safely and successfully become pregnant. Many with lupus turn to IVF when infertility makes it challenging to conceive. On the whole, pregnancy rates (28%) and live birth rates (85%) for those with lupus mirror the general population who turn to IVF.

While IVF is generally successful and safe, it may be riskier for some with lupus and other health conditions like antiphospholipid syndrome.  The risks are mostly associated with the hormone therapies used in IVF and include possible increased lupus flares and blood clots.  Blood clots may also develop for those who do not adhere to their lupus treatment plans. Some may develop ovarian hyperstimulation syndrome due to increased estrogen production. A healthcare practitioner will counsel those who want to pursue IVF and will closely monitor for risks once the procedure has started. Most risks are preventable.

For a great overview of general concerns regarding lupus and pregnancy, check out his article: Lupus and Pregnancy.


In Vitro Fertilization Risks for Lupus

Lupus Flares:  Lupus flares are most commonly due to the hormone manipulations used in in vitro fertilization, but they have also been reported for those who did not adhere to their prescribed lupus treatments.

Ovarian Hyperstimulation Syndrome:  The drugs used in IVF to stimulate ovulation and increase estrogen may cause the ovaries to become painful and swell, resulting in ovarian hyperstimulation syndrome. Sometimes ovarian capillaries leak, causing renal failure, respiratory distress, and even death. A healthcare practitioner will choose effective IVF drugs that pose the least risk based on an individual’s health needs.

Thrombosis:  The risk of developing blood clots from IVF is low and preventable. However, those who do not strictly adhere to lupus may be at higher risk, especially postpartum, when the risk for blood clots is generally high. Treatments to reduce the risk of thrombosis usually involve the careful use of anticoagulants.  Unfortunately, some patients stop their lupus treatments if their attempts at in vitro fertilization fail, and this can increase the risk of thrombosis.

Note: Those with antiphospholipid syndrome (APS) may be at the greatest risk of complications, especially if not previously diagnosed and treated. The most common complication is a lupus flare, while some may develop blood clots, deliver prematurely, or have multi-fetal pregnancies.


Planning, Patience, and Perseverance

IVF is most successful under the following conditions:

  • maintaining low lupus disease activity for 6-12 months;
  • ability to strictly adhere to lupus treatment plans;
  • APS that is well-managed;
  • absence of renal involvement, and
  • absence of pulmonary conditions such as hypertension.

Healthcare practitioners recommend counseling and careful planning to avoid risks. It is essential to be patient and persevere because IVF may take several cycles to result in a pregnancy.  It is also imperative to continue following lupus treatment plans unless otherwise advised by a practitioner. Remaining honest with practitioners about physical symptoms and emotional stress can help them provide the best care possible to ensure a safe pregnancy and routine delivery.


In Conclusion

IVF is a relatively safe and successful means for those with lupus who struggle with infertility to become pregnant. While it does come with risks for some, most are preventable if detected and treated early.

 

References

Bellver, J. & Pellicer, A. (2009). Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome. Fertility and Sterility, 92(6), 1803-1810. https://doi.org/10.1016/j.fertnstert.2009.06.033

Levine, A. & Lockshin, M. (2014). Assisted reproductive technology in SLE and APS. Lupus, 23, 1239-1241. https://doi.org/10.1177%2F0961203314527370

Orquevaux, P., Masseau, A., Le Guern, V., Gayet, V., Vauthier, D., Guettrot-Imbert, G., Hyong, D., Wechsler, b., Morel, N., Cacoub, P., Pennaforte, J., Piette, J., & Costedoat-Chalumeau. (2017). In vitro fertilization in 37 women with systemic lupus erythematosus or antiphospholipid syndrome: a series of 97 procedures. The Journal of Rheumatology, 44(5), 613-618. https://doi.org/10.3899/jrheum.160462

 

Author: Liz Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at [email protected] for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

 

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