In Vitro Fertilization Treatment in Women with Systemic Lupus Erythematosus

In a new case report, investigators recommend that in women with systemic lupus erythematosus (SLE), physicians must work closely with the woman to determine whether in vitro fertilization (IVF, a procedure where an egg is combined with a sperm in the lab and the fertilized egg is inserted in a uterus) pregnancy may pose high maternal or fetal risks. The determination should include pre-conception counseling and an evaluation of the woman’s disease activity including extent of major organ involvement. 

The report examines the case of a 34-year-old woman who was four months pregnant via IVF. She had SLE, antiphospholipid syndrome (APS), several comorbidities, plus was taking hydroxychloroquine, prednisone, and calcium supplements daily. She developed early-onset hypertension involving renal and hematologicalmanifestations and was admitted to the emergency room. She was diagnosed with flares with lupus nephritis (LN, lupus-related kidney disease). A team of physicians (rheumatologist, nephrologist, and intensivist) began to treat her. The woman and her family were thoroughly counseled about the risks and complications of continuing the pregnancy and delaying treatment and ultimately the woman decided to terminate her pregnancy for her health. 

Determining a woman’s risk of experiencing medical issues during treatment and pregnancy before they seek fertility services is important. The presence of APS should be ruled out before considering assisted reproductive therapy (ART) such as IVF. Women who are more likely to experience difficulties during ART and/or pregnancy should receive detailed counseling from clinicians and be supervised and monitored efficiently throughout pregnancy. Learn more about lupus and pregnancy.

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