Women diagnosed with the lupus and rheumatoid arthritis have, on average, half the amount of children they desire, reveals a new study.
Researchers say that women suffering from these autoimmune diseases are more likely to experience infertility and miscarriage, leading to smaller family sizes.
“Rheumatoid arthritis and lupus and their treatments can pose major problems for women during pregnancy and can even result in birth defects and spontaneous abortion,” said Dr. Kaleb Michaud, lead author of the study. “We hope this study will bring these reproductive-health concerns to the forefront, especially among women in their childbearing years.”
Infertility Treatments for Women with Autoimmune Disease
While there is still very little research available about how female fertility is affected by autoimmune diseases, it is slowly becoming recognized as a legitimate reason to seek infertility treatments.
Dr. Norbert Gleicher, the founder of the Center for Human Reproduction and an expert in fertility and autoimmune diseases expressed that women are often misdiagnosed with “unexplained infertility”, when in fact autoimmune disease is really the main reason a woman cannot conceive or maintain a pregnancy.
“This [present study], reporting that women with rheumatoid arthritis and lupus give birth to fewer children is an important publication because the study reemphasizes the very significant impact autoimmunity has on reproductive success,” said Gleicher. “Unfortunately, this fact has, for too long, been ignored by most members of both of the two medical specialties, involved with affected patients, rheumatologists and obstericians/gynecologists, including reproductive endocrinologists and infertility specialists.”
Women who are believed to have autoimmune-related infertility are often treated first for the underlying disease. In some cases the use of a donor egg, IVF, and other infertility treatments may be needed should the woman remain unable to get pregnant.
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Last week there was an uproar about the preterm labor prevention drug, Makena, jumping from $20 per dose to $1,5000 per dose making this vital drug inaccessible to many. However, a new timely study published this week highlights a new option: a inexpensive hormone gel which can cut the risk of preterm birth by as much as 45 percent.
The Wonder Gel
The gel, called Prochieve, is a progesterone based medication developed by Columbia Laboraties Inc. that has been approved by the Food and Drug Administration for use in women deficient in progesterone as well as in certain infertility treatments. However, Columbia plans to submit a new application to the FDA this year for approval to use Procheive as a preventive medication for preterm deliveries.
In the study conducted by the National Institute of Medicine researchers looked at the effect of the gel on pregnant women with a condition known as a shortened cervix, that accounts for approximately 40 percent of all preterm births. The cervix is the opening of the uterus, similar to that of the neck of a balloon. During pregnancy the cervix remains hard, long and closed until the woman goes into labor. Then the cervix begins to soften, shorten and dilate. However, in some women the cervix begins to shorten early in pregnancy, a strong predictor of an impending preterm birth.
Physicians do not completely understand why the cervix shortens in some women, however, risk factors include women who have undone previous procedures that cause trauma to the cervix including cervical biopsies, D&C after miscarriage and artificial cervical dilation. Furthermore, pregnancy in older women and women who have undergone infertility treatment are more likely to have a preterm delivery than their counterparts.
The Study Results
The researchers looked at 458 women diagnosed with a shortened cervix between 10-20 millimeters in length. Half of the group was given the progesterone gel while the other half were given a placebo. The women who received the gel had a 45 percent decreased risk for preterm delivery (delivery before 33 weeks gestation) than those who did not.
This study is significant because preterm births can cause serious adverse health events in babies. Babies born preterm have a higher risk for respiratory distress syndrome, infections and heart problems among many other complications. Additionally, preterm births are costly to the health care system, adding up to over $26 billion dollars per year.
“The prevention of preterm birth is a major healthcare priority. The ultimate purpose of interventions designed to reduce preterm birth is improvement in infant outcome. To date, no intervention in an asymptomatic patient with a risk factor has demonstrated both a reduction in preterm birth and an improvement in infant outcome… The results of this trial indicate that a combined approach in which transvaginal sonographic cervical length was used to identify patients at risk for preterm delivery and administration of vaginal progesterone gel from the midtrimester of pregnancy until term reduced the rate of both preterm birth before 33 weeks of gestation and respiratory distress syndrome, the most common complication of preterm neonates,” wrote the study’s authors in the concluding portion of the study published in Ultrasound in Obstetrics & Gynecology.
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