Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 84

SLE is a chronic multisystem autoimmune disease with a highly variable course of flares and remissions[1]. It is characterized by the generation of autoantibodies and the deposition of immune complexes in various organs, causing inflammatory responses and tissue damage [2]. SLE is more prevalent in women, with a female to male ratio of 9:1 and mainly affects young women during their childbearing years [3]. Although the etiology of the disease is not yet fully known, the high prevalence of women suffering from SLE suggests that estrogen hormones play a role in its pathogenesis. Some women with SLE experience menstrual irregularities [4]. Anticoagulant drugs or, more rarely, thrombocytopenia, can contribute to menorrhagia. A hypothalamic‐pituitary‐ovarian (HPO) axis dysfunction or lupus nephritis‐related hyperprolactinemia can lead to amenorrhea. Permanent amenorrhea can also be due to premature ovarian failure, autoimmune or drug induced. Despite these issues, reproductive function in women with mild SLE is comparable to the general healthy population [5]. The patient in the Case History presented with a normal ovarian reserve.

Treatment, which includes nonsteroidal anti‐inflammatory drugs, glucocorticoids and immunosuppressive drugs, aims to minimize or stop disease progression and organ damage. Cyclophosphamide (CTX), the agent of choice used to treat severe disease flares, may induce ovarian failure by depletion of oocytes [6]. Gonadotoxic effects of CTX are permanent and related to cumulative dose, age of exposure and treatment duration. SLE can occur in association with other autoimmune diseases, such as antiphospholipid syndrome (APS). APS is a systemic acquired thrombophilic disorder, with a prevalence of 40–50 cases per 100,000 persons [7]. It is characterized by vascular thrombosis and/or obstetric complications in the presence of antiphospholipid (aPL) antibodies (lupus anticoagulant, anticardiolipin antibodies (aCL) or antibeta2 glycoprotein I antibodies) [7]. Diagnosis consists of at least one clinical and one laboratory criteria. The presence of aPL antibodies is not a cause of reduced fertility, hence routine screening is not required in the infertile population [8]. Around 40% of SLE patients carry aPL, and aPL have been shown to be one of the strongest predictors of adverse events, vascular or obstetric. In the Case History, the patient, suffering from SLE with positive aCL antibodies, had a premature delivery <34 weeks of gestation due to severe preeclampsia and fetal growth restriction, and thrombotic complications in the postpartum period.