Orquevaux P, Masseau A, Le Guern V, Gayet V, Vauthier D, Boutin D, Wechsler B, Morel N, Guettrot-Imbert G, Pennaforte J-L, Piette J-C, Costedoat-Chalumeau N
Service de médecine interne, centre de compétence maladies auto-immunes et systémiques rares, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France.
Service de médecine interne, centre de compétence maladies auto-immunes et systémiques rares, Hôtel Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Rev Med Interne. 2015 Mar;36(3):154-8. doi: 10.1016/j.revmed.2014.08.004. Epub 2014 Sep 10.
Fertility is not impaired in systemic lupus erythematosus or antiphospholipid syndrome, but, similarly to the general population, these patients may undergo in vitro fertilization. This type of treatment increases the risk of lupus flare, thrombosis, and ovarian hyperstimulation syndrome. This review will focus on in vitro fertilization in systemic lupus erythematosus or antiphospholipid syndrome. Literature data are relatively scant with only 3 reported studies. The first one included 17 patients and 63 cycles of induction ovulation/in vitro fertilization leading to 25 % of lupus flare, no thrombosis, and 3 % of ovarian hyperstimulation syndrome. The second study included 10 patients and 40 cycles of in vitro fertilization showing 31 % of lupus flare, no thrombosis and no ovarian hyperstimulation syndrome. The last one included 34 patients and 83 procedures of in vitro fertilization leading to 8 % of flares, 5 % of thrombosis and no ovarian hyperstimulation syndrome. Interestingly, in this last study, half of the complications were explained by poor adherence to treatment. These data are reassuring but it is important to remember that in vitro fertilization should be scheduled and carefully supervised in the same way as the high-risk pregnancies occurring in these patients.
系统性红斑狼疮或抗磷脂综合征患者的生育能力并未受损，但与普通人群一样，这些患者可能会接受体外受精。这种治疗方式会增加狼疮发作、血栓形成和卵巢过度刺激综合征的风险。本综述将聚焦于系统性红斑狼疮或抗磷脂综合征患者的体外受精情况。文献数据相对较少，仅有3项报道的研究。第一项研究纳入了17名患者和63个诱导排卵/体外受精周期，结果显示狼疮发作率为25%，无血栓形成，卵巢过度刺激综合征发生率为3%。第二项研究纳入了10名患者和40个体外受精周期，狼疮发作率为31%，无血栓形成，也无卵巢过度刺激综合征。最后一项研究纳入了34名患者和83例体外受精手术，发作率为8%，血栓形成率为5%，无卵巢过度刺激综合征。有趣的是，在最后这项研究中，一半的并发症是由于治疗依从性差所致。这些数据令人安心，但重要的是要记住，体外受精的安排和监管应与这些患者发生的高危妊娠一样谨慎。
