Background: SADs, which frequently affect women of childbearing age, have been shown to affect fertility. Some medical disorders, like arthritis, may not specifically preclude the use of assisted reproductive technologies (ARTs). Contrarily, patients with connective tissue disorders (CTD), particularly those with antiphospholipid antibody syndrome (APS) and systemic lupus erythematosus (SLE), require more specialist care and tailored therapy for ARTs and pregnancy.

Objectives: This study aims to assess the response to ARTs in patients with SADs, both in terms of the underlying disease’s reactivation and the effectiveness of the ARTs.

Methods: Between January 2010 and December 2023, 97 SAD patients (77/95 referred to the “Polyabortivity Outpatient Clinics” at San Raffaele Hospital’s Centro Scienze delle Natalità, Milan, 12/95 referred to “Rheumatology Outpatient Clinics” at University Hospital of Padua and 8/95 referred to “Rheumatology Outpatient Clinics” at Azienda Ospedaliera di Ferrara) underwent 162 ART cycles (140 from San Raffaele, 14 from Padua and 8 from Ferrara). Information regarding ART technique and obstetrical outcome was retrospectively gathered.

Results: 39/162 (24%) stimulations were performed in patients with APS, 24/162 (15%) in SLE patients, 21/162 (13%) in patients with undifferentiated CTD, 15/162 (9%) patients had rheumatoid arthritis (RA), 8/162 (5%) psoriatic arthritis (PsA), 4/162 (3%) autoimmune thrombocytopenia, 20/162 (12%) Sjogren’s Syndrome (SS), 5/162 (3%) Systemic Sclerosis (SSc) and 26/162 (16%) multiple positivity for antiphospholipid antibodies (aPL) without clinical history of APS.

Patients were receiving low dose aspirin (LDA) alone in 63/162 (39%) and LDA+LMWH in 44/162 (27%) of the stimulations. Aside from that, hydroxychloroquine (HCQ) was given in 59/162 cases (36%) as well as 27/162 cases (17%) of steroid therapy and 15/162 cases (9%) of immunosuppressive medication

We observed 79/162 (49%) beta-hCG negative pregnancies, 24/162 (15%) losses before the 10th week of pregnancy, 3/162 (2%) miscarriages after the 10th week of pregnancy, 47/162 (29%) full-term births and 6/162 (43%) preterm births (4/162 (2%) still-developing pregnancies).

We observed a reactivation of the underlying autoimmune disease in four pregnancies: in one patient with PsA, the peripheral arthritis worsened, necessitating more steroid therapy soon after delivery, in two SLE patient, (one developed lupus nephritis at conception and one had SLE flare during pregnancy) and one patient with AR necessitated starting of immunosuppressive therapy during pregnancy.

Conclusion: In 158/162 (98%) cycles, ARTs did not result in illness flares. A live newborn was delivered in 52/162 (32%) of the cycles. Additionally, there was no discernible difference in the results of ARTs between women with and without SADs (data from ESHRE report 2021). Our findings support the use of ARTs in SADs patients with effective underlying illness management. Future prospective trials on bigger cohorts of SAD patients may offer more accurate information on the results and safety of AR.

REFERENCES: NIL.

Acknowledgements: NIL.

Disclosure of Interests: None declared.