Подходы к реализации репродуктивной функции у женщин с системной красной волчанкой и антифосфолипидным синдромом
Подходы к реализации репродуктивной функции у женщин с системной красной волчанкой и антифосфолипидным синдромом
Власова Г.А., Перминова С.Г., Кошелева Н.М. Подходы к реализации репродуктивной функции у женщин с системной красной волчанкой и антифосфолипидным синдромом. Гинекология. 2021; 23 (2): 167–172.
DOI: 10.26442/20795696.2021.2.200739
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Vlasova GA, Perminova SG, Kosheleva NM. Approaches to the realization of reproductive function in women with systemic lupus erythematosus and antiphospholipid syndrome. Gynecology. 2021; 23 (2): 167–172.
DOI: 10.26442/20795696.2021.2.200739
Подходы к реализации репродуктивной функции у женщин с системной красной волчанкой и антифосфолипидным синдромом
Власова Г.А., Перминова С.Г., Кошелева Н.М. Подходы к реализации репродуктивной функции у женщин с системной красной волчанкой и антифосфолипидным синдромом. Гинекология. 2021; 23 (2): 167–172.
DOI: 10.26442/20795696.2021.2.200739
________________________________________________
Vlasova GA, Perminova SG, Kosheleva NM. Approaches to the realization of reproductive function in women with systemic lupus erythematosus and antiphospholipid syndrome. Gynecology. 2021; 23 (2): 167–172.
DOI: 10.26442/20795696.2021.2.200739
Цель. Оценить безопасность и эффективность применения программ вспомогательных репродуктивных технологий (ВРТ) у больных системной красной волчанкой (СКВ) с/без сопутствующего антифосфолипидного синдрома (АФЛС). Материалы и методы. В наблюдательное исследование включены 26 больных достоверной СКВ, 7 из которых – с сопутствующим АФЛС и нарушениями репродуктивной функции. Анализ причин нарушения фертильности основывался на данных анамнеза и комплексного обследования, которые, как и факторы риска возможных осложнений, определяли выбор программ ВРТ. Результаты. У 23 из 26 пациенток было диагностировано бесплодие (в 14 случаях – первичное и 9 – вторичное), у 3 – привычное невынашивание беременности. Основными этиологическими факторами бесплодия были трубный (n=6), мужской (n=8) и их сочетание (n=3), в 9 случаях генез бесплодия остался неясным. Десять больных с волчаночным нефритом в анамнезе имели сниженный овариальный резерв. Всего 23 пациенткам с бесплодием проведено 33 программы экстракорпорального оплодотворения. Было зарегистрировано 11 (33%) клинических беременностей, из которых 7 завершились рождением живого ребенка. Случаев тяжелого обострения СКВ и тромботических осложнений не зарегистрировано. Заключение. ВРТ могут применяться у больных СКВ с/без АФЛС при условии компенсации основного заболевания и профилактики осложнений. Эффективность программ ВРТ сопоставима с таковой в общей популяции. Для окончательного суждения о безопасности различных программ ВРТ при СКВ с/без АФЛС необходимы дальнейшие исследования.
Aim. To assess the safety and efficacy of assisted reproductive technology (ART) programs in patients with systemic lupus erythematosus (SLE) with/without comorbid antiphospholipid syndrome (APLS). Materials and methods. The observational study included 26 patients with diagnosed SLE, of whom 7 women had comorbid APLS and disorders of reproductive function. The analysis of the causes of impaired fertility was based on history and comprehensive examination data, which, along with risk factors for possible complications, determined the choice of ART programs. Results. In 23 of 26 patients, infertility (primary: 14, secondary: 9) was diagnosed, and 3 patients were diagnosed with repeated miscarriage. The main etiological factors of infertility were tubal (n=6), male (n=8) and their combination (n=3); in 9 cases the etiology of infertility remained unclear. 10 patients with a history of lupus nephritis had a reduced ovarian reserve. In total, 23 infertile patients underwent 33 in vitro fertilization programs. 11 (33%) clinical pregnancies were registered, of which 7 ended in live birth. There were no cases of severe exacerbation of SLE and thrombotic complications. Conclusion. ART can be used in patients with SLE with / without APLS, if the underlying disease is compensated for and prevention for complications is used. The effectiveness of ART programs is comparable to that in the general population. Further research is needed to make a final judgment on the safety of various ART programs in SLE with/without APLS.
1. Geva E, Lerner-Geva L, Burke M, et al. Undiagnosed systemic lupus erythematosus in a cohort of infertile women. Am J Reprod Immunol. 2004; 51: 336–40.
2. Madhok R, Wu O. Systemic lupus erythematosus. Am Pham Physician. 2007; 76: 1351–3.
3. Oktem O, Hande Y, Hale B, Bulent U. Reproductive aspects of systemic lupus erythematosus. J Reprod Immunol. 2016; 117: 57–65.
4. Nannini C, Jebakumar AJ, Crowson CS, et al. Primary Sjogren’s syndrome 1976–2005 and associated interstitial lung disease: a population 15 based study of incidence and mortality. BMJ Open. 2013; 3: e003569.
5. Chiche L, Jourde N, Ulmann C, et al. Seasonal variations of systemic lupus erythematosus flares in southern France. Eur Journal Intern Med. 2012; 23 (3): 250–4.
6. Baker WF, Bick RL. The clinical spectrum of antiphospholipid syndrome. Hematol Oncol Clin North Am. 2008; 22: 33–52.
7. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4: 295–306.
8. Bellver J, Pellicer A. Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome. Fertil Steril. 2009; 92 (6): 1803–10. DOI: 10.1016/j.fertnstert.2009.06.033
9. Costa M, Colia D. Treating infertility in autoimmune patients. Rheumatology. 2008; 47 (Suppl. 3): iii38–41.
10. Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017; 76 (3): 76–85. DOI: 10.1136/annrheumdis-2016-209770
11. Østensen M. Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol. 2017; 13 (8): 85–93. DOI: 10.1038/nrrheum.2017.102
12. Somers EC, Marder W. Infertility-Prevention and Management. Rheum Dis Clin North Am. 2017; 43 (2): 75–85. DOI: 10.1016/j.rdc.2016.12.007
13. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4 (2): 295–306. DOI: 10.1111/j.1538-7836.2006.01753.x
14. Mecacci F, Pieralli A, Bianchi B, Paidas MJ. The impact of autoimmune disorders and adverse pregnancy outcome. Semin Perinatol. 2007; 31: 223–6.
15. Brunner HI, Silva CA, Reiff A, et al. Randomized Double-Blinded Dose Escalation Trial of Triptorelin for Ovary Protection in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol. 2015; 67 (5): 1377–85. DOI: 10.1002/art.39024
16. Dias JJ, de Oliveira RM, Abrao MS. Antinuclear antibodies and endometriosis. Int J Gynaecol Obstet. 2006; 93 (3): 262–3. DOI: 10.1016/j.ijgo.2006.03.005
17. Ticconi C, Rotondi F, Veglia M, et al. Antinuclear autoantibodies in women with recurrent pregnancy loss. Am J Reprod Immunol. 2010; 64 (6): 384–92.
DOI: 10.1111/j.1600-0897.2010.00863.x
18. Fan J, Zhong Y, Chen C. Impacts of Anti-dsDNA Antibody on In Vitro Fertilization-Embryo Transfer and Frozen-Thawed Embryo Transfer.
J Immunol Res. 2017; 2017: 8596181. DOI: 10.1155/2017/8596181
19. Carp HJ, Shoenfeld Y. Anti-phospholipid antibodies and infertility. Clin Rev Allergy Immunol. 2007; 32: 159–61.
20. Di Somone N, Meroni PL, de Papa N, et al. Antiphospholipid antibodies affect trophoblast gonadotropin secretion and invasiveness by binding directly and through adhered beta2-glycoprotein-I. Arthritis Rheum. 2000; 43: 140–50. DOI: 10.1002/1529-0131(200001)43:1<140::AID-ANR18>3.0.CO;2-P
21. Lyden T, Vogt E, Ng AK, et al. Monoclonal antiphospholipid antibody reactivity against human placental trophoblast. J Reprod Immunol. 1992; 22: 1–14.
DOI: 10.1016/0165-0378(92)90002-l
22. Kaider AS, Kaider BD, Janowicz PB, Roussev RG. Immunodiagnostic evaluation in women with reproductive failure. Am J Reprod Immunol. 1999; 42 (6): 335–46.
DOI: 10.1111/j.1600-0897.1999.tb00110.x
23. Mardesic T, Ulcova-Gallova Z, Huttelova R, et al. The influence of different types ofantibodies on in vitro fertilization results. Am J Reprod Immunol. 2000; 43: 1–5. DOI: 10.1111/j.8755-8920.2000.430101.x
24. Eldar-Geva T, Wood C, Lolatgis N, et al. Cumulative pregnancy and livebirth rates in women with antiphospholipid antibodies under going assisted reproduction. Hum Reprod. 1999; 14: 1461–6. DOI: 10.1093/humrep/14.6.1461
25. American Society for Reproductive Medicine. A Practice Committee report. Antiphospholipid antibodies do not affect IVF success. Birmingham, AL, USA, 1999; p. 1–3.
26. Hornstein MD, Davis OK, Massey JB, et al. Antiphospholipid antibodies and in vitro fertilization success: a meta-analysis. Fertil Steril. 2000; 73: 330–333.
DOI: 10.1016/s0015-0282(99)00498-7
27. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020; 72 (4): 529–6. DOI: 10.1002/art.41191
28. Shulman A. Safety of IVF under anticoagulant therapy in patients at risk for thromboembolic events. Reprod Biomed Online. 2006; 12: 354–8.
________________________________________________
1. Geva E, Lerner-Geva L, Burke M, et al. Undiagnosed systemic lupus erythematosus in a cohort of infertile women. Am J Reprod Immunol. 2004; 51: 336–40.
2. Madhok R, Wu O. Systemic lupus erythematosus. Am Pham Physician. 2007; 76: 1351–3.
3. Oktem O, Hande Y, Hale B, Bulent U. Reproductive aspects of systemic lupus erythematosus. J Reprod Immunol. 2016; 117: 57–65.
4. Nannini C, Jebakumar AJ, Crowson CS, et al. Primary Sjogren’s syndrome 1976–2005 and associated interstitial lung disease: a population 15 based study of incidence and mortality. BMJ Open. 2013; 3: e003569.
5. Chiche L, Jourde N, Ulmann C, et al. Seasonal variations of systemic lupus erythematosus flares in southern France. Eur Journal Intern Med. 2012; 23 (3): 250–4.
6. Baker WF, Bick RL. The clinical spectrum of antiphospholipid syndrome. Hematol Oncol Clin North Am. 2008; 22: 33–52.
7. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4: 295–306.
8. Bellver J, Pellicer A. Ovarian stimulation for ovulation induction and in vitro fertilization in patients with systemic lupus erythematosus and antiphospholipid syndrome. Fertil Steril. 2009; 92 (6): 1803–10. DOI: 10.1016/j.fertnstert.2009.06.033
9. Costa M, Colia D. Treating infertility in autoimmune patients. Rheumatology. 2008; 47 (Suppl. 3): iii38–41.
10. Andreoli L, Bertsias GK, Agmon-Levin N, et al. EULAR recommendations for women’s health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis. 2017; 76 (3): 76–85. DOI: 10.1136/annrheumdis-2016-209770
11. Østensen M. Sexual and reproductive health in rheumatic disease. Nat Rev Rheumatol. 2017; 13 (8): 85–93. DOI: 10.1038/nrrheum.2017.102
12. Somers EC, Marder W. Infertility-Prevention and Management. Rheum Dis Clin North Am. 2017; 43 (2): 75–85. DOI: 10.1016/j.rdc.2016.12.007
13. Miyakis S, Lockshin MD, Atsumi T, et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006; 4 (2): 295–306. DOI: 10.1111/j.1538-7836.2006.01753.x
14. Mecacci F, Pieralli A, Bianchi B, Paidas MJ. The impact of autoimmune disorders and adverse pregnancy outcome. Semin Perinatol. 2007; 31: 223–6.
15. Brunner HI, Silva CA, Reiff A, et al. Randomized Double-Blinded Dose Escalation Trial of Triptorelin for Ovary Protection in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol. 2015; 67 (5): 1377–85. DOI: 10.1002/art.39024
16. Dias JJ, de Oliveira RM, Abrao MS. Antinuclear antibodies and endometriosis. Int J Gynaecol Obstet. 2006; 93 (3): 262–3. DOI: 10.1016/j.ijgo.2006.03.005
17. Ticconi C, Rotondi F, Veglia M, et al. Antinuclear autoantibodies in women with recurrent pregnancy loss. Am J Reprod Immunol. 2010; 64 (6): 384–92.
DOI: 10.1111/j.1600-0897.2010.00863.x
18. Fan J, Zhong Y, Chen C. Impacts of Anti-dsDNA Antibody on In Vitro Fertilization-Embryo Transfer and Frozen-Thawed Embryo Transfer.
J Immunol Res. 2017; 2017: 8596181. DOI: 10.1155/2017/8596181
19. Carp HJ, Shoenfeld Y. Anti-phospholipid antibodies and infertility. Clin Rev Allergy Immunol. 2007; 32: 159–61.
20. Di Somone N, Meroni PL, de Papa N, et al. Antiphospholipid antibodies affect trophoblast gonadotropin secretion and invasiveness by binding directly and through adhered beta2-glycoprotein-I. Arthritis Rheum. 2000; 43: 140–50. DOI: 10.1002/1529-0131(200001)43:1<140::AID-ANR18>3.0.CO;2-P
21. Lyden T, Vogt E, Ng AK, et al. Monoclonal antiphospholipid antibody reactivity against human placental trophoblast. J Reprod Immunol. 1992; 22: 1–14.
DOI: 10.1016/0165-0378(92)90002-l
22. Kaider AS, Kaider BD, Janowicz PB, Roussev RG. Immunodiagnostic evaluation in women with reproductive failure. Am J Reprod Immunol. 1999; 42 (6): 335–46.
DOI: 10.1111/j.1600-0897.1999.tb00110.x
23. Mardesic T, Ulcova-Gallova Z, Huttelova R, et al. The influence of different types ofantibodies on in vitro fertilization results. Am J Reprod Immunol. 2000; 43: 1–5. DOI: 10.1111/j.8755-8920.2000.430101.x
24. Eldar-Geva T, Wood C, Lolatgis N, et al. Cumulative pregnancy and livebirth rates in women with antiphospholipid antibodies under going assisted reproduction. Hum Reprod. 1999; 14: 1461–6. DOI: 10.1093/humrep/14.6.1461
25. American Society for Reproductive Medicine. A Practice Committee report. Antiphospholipid antibodies do not affect IVF success. Birmingham, AL, USA, 1999; p. 1–3.
26. Hornstein MD, Davis OK, Massey JB, et al. Antiphospholipid antibodies and in vitro fertilization success: a meta-analysis. Fertil Steril. 2000; 73: 330–333.
DOI: 10.1016/s0015-0282(99)00498-7
27. Sammaritano LR, Bermas BL, Chakravarty EE, et al. 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis Rheumatol. 2020; 72 (4): 529–6. DOI: 10.1002/art.41191
28. Shulman A. Safety of IVF under anticoagulant therapy in patients at risk for thromboembolic events. Reprod Biomed Online. 2006; 12: 354–8.
Авторы
Г.А. Власова*1, С.Г. Перминова1, Н.М. Кошелева2
1 ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии имени академика В.И. Кулакова» Минздрава России, Москва, Россия;
2 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия
*galinavlasova089@gmail.com
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Galina A. Vlasova*1, Svetlana G. Perminova1, Nadezhda M. Kosheleva2
1 Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2 Nasonova Research Institute of Rheumatology, Moscow, Russia
*galinavlasova089@gmail.com