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Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome
Fertility and Sterility, 07/31/09

Bellver J et al. – Data demonstrate that ovarian stimulation for ovulation induction and in vitro fertilization (IVF) seems to be safe and successful in well-selected women with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).

• A review of the current evidence regarding:
  • Relationship between SLE and APS and female infertility, and
  • Risks associated with ovarian stimulation for ovulation induction and IVF
• Based on this information, guidelines for safe and successful assisted reproductive technology (ART) was developed
• A MEDLINE computer search was performed to identify relevant articles

• SLE and APS are not related to infertility, except for cases of:
  • Amenorrhea accompanying severe flares
  • Renal insufficiency-related hypofertility, and
  • Ovarian failure secondary to cyclophosphamide (CTX) therapy
• Most threatening conditions in affected women undergoing ovarian stimulation are lupus flares and thrombosis
• Latter being especially associated with the occurrence of an overt ovarian hyperstimulation syndrome (OHSS)
• Safest approaches:
  • Friendly ovarian stimulation
  • Single embryo transfer
  • Avoidance of OHSS
  • Administration of coadjuvant therapy, and
  • Use of natural E2 or P through a nonoral route
• Situations on which to discourage ART, especially due to the high risk of complications for both mother and fetus during pregnancy and puerperium:
  • Systemic lupus manifested in acute flares
  • Badly controlled arterial hypertension
  • Pulmonary hypertension
  • Advanced renal disease
  • Severe valvulopathy or heart disease, and major previous thrombotic events

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