PO:14:199 | Preliminary data of a multicentric study on safety and efficacy of assisted reproductive techniques in pregnant women with systemic autoimmune diseases

Valentina Canti¹, Maria Bernadette Cilona¹, Giuditta Gorgone¹, Federica Pasi¹, Antonia Calligaro², Francesca Ruffilli³, Francesca Crisafulli⁶, Maria Tonello², Eleonora Giacobbe⁴, Alba Chiara Pozzi⁶, Maria Chiara Gerardi⁴, Melissa Padovan³, Emanuele Bizzi⁵, Enrico Papaleo¹, Beatrice Maranini³, Marcello Govoni³, Massimiliano Epis⁴, Angela Tincani⁶, Andrea Doria², Patrizia Rovere Querini¹ | ¹IRCCS Ospedale San Raffaele and VitaSalute San Raffaele Milano, Italy; ²Rheumatology Unit, Departement of Medicine, University Hospital of Padua Padova, Italy; ³Rheumatology Unit, Azienda Ospedaliero Universitaria S. Anna Ferrara, Department of Medical Sciences, University of Fe Ferrara, Italy; ⁴ASST Grande Ospedale Metropolitano Niguarda Milano, Italy; ⁵Internal Medicine, Fatebenefratelli Hospital Milano, Italy; ⁶Rheumatology and Immunology Unit, ASST Spedali Civili Brescia e Università degli Studi di Brescia, Italy

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. 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 May 2025 we collected 268 ART cycles (207 from San Raffaele Hospital, 18 from Padua, 8 from Ferrara, 7 from Niguarda Hospital, 11 from Fatebenefratelli Hospital and 17 from Spedali Civili di Brescia). Information regarding ART technique and obstetrical outcome was retrospectively gathered.

Results. 64/268 (24%) stimulations were performed in patients with APS, 35/268 (13%) in SLE patients, 82/268 (30%) in patients with CTD, 42/268 (16%) in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA) and 45/268 (17%) multiple positivity for antiphospholipid antibodies (aPL) without clinical history of APS. Patients were receiving low dose aspirin (LDA) alone in112/268 (42%) and LDA+LMWH in 78/268 (29%) of the stimulations. Aside from that, hydroxychloroquine (HCQ) was given in 100/268 cases (37%) as well as 54/268 cases (20%) of steroid therapy and 31/268 cases (11%) of immunosuppressive medication. We observed 119/268 (44%) beta-hCG negative pregnancies, 28/268 (10%) losses before the 10th week of pregnancy, 5/268 (2%) miscarriages after the 10th week of pregnancy, 116/268 (43%) delivered an alive babies (9/268 (3%) preterm births). In a subgroup analysis only 10/33 (30%) patients underwent ARTs before 2012 delivered a baby. We observed a reactivation of the underlying autoimmune disease in five 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 two patient with AR necessitated starting of immunosuppressive therapy during pregnancy.

Conclusions. In 263/268 (98%) cycles, ARTs did not result in illness flares. A live newborn was delivered in 116/268 (43%) 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, especially in the last decades, with effective underlying illness management and with and a favorable pregnancy outcome. Future prospective trials on bigger cohorts of SAD patients may offer more accurate information on the results and safety of ARTs.