Otoinflamatuar veya Otoimmün Hastalıkları Olan 60 Kadında İn Vitro Fertilizasyon: Tek Merkez Deneyimi

Yıl 2025, Cilt: 11 Sayı: 3, 396 - 403, 29.09.2025

Gül Alkan Bulbul , Emine Kirtiş , Sefa Metehan Ceylan , Şafak Olgan , Murat Özekinci , Cem Sanhal , İnanç Mendilcioğlu

https://doi.org/10.53394/akd.1539790

Öz

Amaç: Otoimmün ve otoinflamatuar hastalıklar, kadınların gebe kalma zamanlamasını ve yeteneğini geciktirebilmektedir. Bugüne kadar, otoimmün ve otoinflamatuar hastalıklar ile ilişkili infertilitede İn Vitro Fertilizasyonun (IVF) sonuçlarına ilişkin çok az veri mevcuttur. Mevcut çalışmada, en sık görülen tiroid bezine karşı otoimmün hastalıklar dışında otoimmün hastalıklardan veya otoinflamatuar hastalıklardan en az birine sahip kadınlarda IVF deneyimini bildirdik.
Gereç ve Yöntemler: En az bir otoimmün veya otoinflamatuar hastalığı olan ve 2014 ile 2023 yılları arasında en az bir IVF prosedürü geçirmiş kadınlar üzerinde retrospektif bir analiz yapıldı.
Bulgular: Çalışmaya toplam 74 IVF uygulanan 60 kadın dahil edildi. Hastaların %26,6' sını etkileyerek romatoid artrit en sık karşılaşılan otoimmün hastalık olup bunu %25 ile Ailesel Akdeniz Ateşi izledi. Azalmış overyan rezervi infertilitenin birincil nedeniydi ve örnek popülasyonun %64,9'unu etkiledi. IVF sırasındaki ortalama yaş 33 idi. Yetmişdört IVF siklusunun 15'inde gebelik elde edildi, bunun 9'u canlı doğum (%60) ve 6'sı abortus (%40) ile sonuçlandı. IVF klinik gebelik oranı %20,2, canlı doğum oranı ise %12,1 olarak gerçekleşti. Obstetrik komplikasyonlar arasında preterm doğum, preeklampsi ve fetal büyüme kısıtlılığından oluşan birer vaka yer alıyordu. Anne veya yenidoğan ölümü yaşanmadı ve overyan hiperstimülasyon sendromu vakası bildirilmedi.
Sonuç: Bu çalışmada otoimmün ve otoinflamatuar hastalıkları olan 60 hastada IVF sonuçlarını analiz ettik. IVF prosedürü, nispeten düşük gebelik ve canlı doğum oranları gösterdi. Bununla birlikte, devam eden gebeliklerin yarıdan fazlası canlı doğum ile sonuçlanmıştır. IVF, otoimmün-otoinflamatuar hastalıkları olan hastalarda doğurganlık tedavisi için umut verici bir seçenek olmaya devam etmektedir.

Anahtar Kelimeler

otoimmün , otoinflamatuar , tüp bebek , kısırlık , gebelik

In Vitro Fertilization in 60 Women with Auto-inflammatory or Uncommon Autoimmune Diseases: A Single-Center Experience

Öz

Objective: Autoimmune and auto-inflammatory diseases can affect both the timing and ability of women to conceive. There is limited data addressing the outcomes of in vitro fertilisation (IVF) in autoimmune and auto-inflammatory-related infertility. This study presents the IVF experience in women diagnosed with at least one auto-inflammatory disease or autoimmune disorder except for the more common autoimmune disorders that primarily impact the thyroid gland.
Material and Methods: A retrospective analysis was performed on women diagnosed with at least one autoimmune or auto-inflammatory disease and had undergone at least one IVF cycle between 2014 and 2023.
Results: The study included 60 women who underwent a total of 74 IVF procedures. Rheumatoid arthritis was the most common autoimmune condition, affecting 26.6% of the patients, closely followed by Familial Mediterranean Fever (FMF) in 25% of the patients. The main factor causing infertility in the sample population was the diminished ovarian reserve, which affected around 64.9% of the participants. The median age at the time of IVF was 33 years. Out of 74 IVF cycles, there were 15 pregnancies, resulting in 9 live births (60%) and 6 miscarriages (40%). The IVF clinical pregnancy rate was 20.2% and the live birth rate was 12.1%. Obstetric complications included one case each of preterm birth, preeclampsia, and fetal growth restriction. No maternal or neonatal deaths occurred, and no cases of ovarian hyperstimulation syndrome were reported.
Conclusion: The outcomes of IVF in 60 patients diagnosed with autoimmune and auto-inflammatory diseases were analysed in this study. The IVF procedure exhibited comparatively low pregnancy and live birth rates. However, more than half of the on-going pregnancies resulted in live births. IVF remains a promising option for fertility treatment in patients with autoimmune diseases.

Anahtar Kelimeler

autoimmune , auto-inflammatory , in-vitro fertilization , infertility , pregnancy

Kaynakça

• 1. Fertility evaluation of infertile women: a committee opinion. Fertil Steril 2021; 116(5):1255-65.
• 2. Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. Am Fam Physician 2015; 91(5):308-14.
• 3. Deroux A, Dumestre-Perard C, Dunand-Faure C, Bouillet L, Hoffmann P. Female Infertility and Serum Auto-antibodies: a Systematic Review. Clin Rev Allergy Immunol 2017; 53(1):78-86.
• 4. Chen X, Mo ML, Huang CY, Diao LH, Li GG, Li YY, Lerner A, Shoenfeld Y, Zeng Y. Association of serum autoantibodies with pregnancy outcome of patients undergoing first IVF/ICSI treatment: A prospective cohort study. J Reprod Immunol 2017; 122:14-20.
• 5. Micu MC, Micu R, Ostensen M. Luteinized unruptured follicle syndrome increased by inactive disease and selective cyclooxygenase 2 inhibitors in women with inflammatory arthropathies. Arthritis Care Res (Hoboken) 2011; 63(9):1334-8.
• 6. Golding A, Haque UJ, Giles JT. Rheumatoid arthritis and reproduction. Rheum Dis Clin North Am 2007; 33(2):319-43, vi-vii.
• 7. Sotskiy PO, Sotskaya OL, Hayrapetyan HS, Sarkisian TF, Yeghiazaryan AR, Atoyan SA, Ben-Chetrit E. Infertility Causes and Pregnancy Outcome in Patients With Familial Mediterranean Fever and Controls. J Rheumatol 2021; 48(4):608-14.
• 8. Kostrzewa M, Zyla M, Garnysz K, Kaczmarek B, Szyllo K, Grzesiak M. Anti-Mullerian hormone as a marker of abortion in the first trimester of spontaneous pregnancy. Int J Gynaecol Obstet 2020; 149(1):66-70.
• 9. Merz WM, Fischer-Betz R, Hellwig K, Lamprecht G, Gembruch U. Pregnancy and Autoimmune Disease. Dtsch Arztebl Int 2022; 119(9):145-56.
• 10. Yasar O, Iskender C, Kaymak O, Taflan Yaman S, Uygur D, Danisman N. Retrospective evaluation of pregnancy outcomes in women with familial Mediterranean fever. J Matern Fetal Neonatal Med 2014; 27(7):733-6.
• 11. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocr Rev 2010; 31(5):702-55.
• 12. Vissenberg R, Manders VD, Mastenbroek S, Fliers E, Afink GB, Ris-Stalpers C, Goddijn M, Bisschop PH. Pathophysiological aspects of thyroid hormone disorders/thyroid peroxidase autoantibodies and reproduction. Hum Reprod Update 2015; 21(3):378-87.
• 13. Toulis KA, Goulis DG, Venetis CA, Kolibianakis EM, Negro R, Tarlatzis BC, Papadimas I. Risk of spontaneous miscarriage in euthyroid women with thyroid autoimmunity undergoing IVF: a meta-analysis. Eur J Endocrinol 2010; 162(4):643-52.
• 14. Leiva P, Schwarze JE, Vasquez P, Ortega C, Villa S, Crosby J, Balmaceda J, Pommer R. There is no association between the presence of anti-thyroid antibodies and increased reproductive loss in pregnant women after ART: a systematic review and meta-analysis. JBRA Assist Reprod 2017; 21(4):361-5.
• 15. Busnelli A, Paffoni A, Fedele L, Somigliana E. The impact of thyroid autoimmunity on IVF/ICSI outcome: a systematic review and meta-analysis. Hum Reprod Update 2016; 22(6):775-90.
• 16. Azhar E, Seifer DB, Melzer K, Ahmed A, Weedon J, Minkoff H. Knowledge of ovarian reserve and reproductive choices. J Assist Reprod Genet 2015; 32(3):409-15.
• 17. Ayesha, Jha V, Goswami D. Premature Ovarian Failure: An Association with Autoimmune Diseases. J Clin Diagn Res 2016; 10(10):Qc10-qc2.
• 18. Carp HJ, Selmi C, Shoenfeld Y. The autoimmune bases of infertility and pregnancy loss. J Autoimmun 2012; 38(2-3):J266-74.
• 19. Vega M, Barad DH, Yu Y, Darmon SK, Weghofer A, Kushnir VA, Gleicher N. Anti-mullerian hormone levels decline with the presence of antiphospholipid antibodies. Am J Reprod Immunol 2016; 76(4):333-7.
• 20. Henes M, Froeschlin J, Taran FA, Brucker S, Rall KK, Xenitidis T, Igney-Oertel A, Lawrenz B, Henes JC. Ovarian reserve alterations in premenopausal women with chronic inflammatory rheumatic diseases: impact of rheumatoid arthritis, Behçet's disease and spondyloarthritis on anti-Müllerian hormone levels. Rheumatology (Oxford) 2015; 54(9):1709-12.
• 21. Götestam Skorpen C, Lydersen S, Gilboe IM, Skomsvoll JF, Salvesen KÅ, Palm Ø, Koksvik HSS, Jakobsen B, Wallenius M. Women with systemic lupus erythematosus get pregnant more easily than women with rheumatoid arthritis. Rheumatology (Oxford) 2018; 57(6):1072-9.
• 22. Ismajovich B, Zemer D, Revach M, Serr DM, Sohar E. The causes of sterility in females with familial Mediterranean fever. Fertil Steril 1973; 24(11):844-7.
• 23. Zayed A, Nabil H, State O, Badawy A. Subfertility in women with familial Mediterranean fever. J Obstet Gynaecol Res 2012; 38(10):1240-4.
• 24. Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update 2002; 8(6):559-77.
• 25. McLernon DJ, Steyerberg EW, Te Velde ER, Lee AJ, Bhattacharya S. Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women. Bmj 2016; 355:i5735.
• 26. Gleicher N, Kushnir VA, Barad DH. Worldwide decline of IVF birth rates and its probable causes. Hum Reprod Open 2019; 2019(3):hoz017.
• 27. Papamentzelopoulou M, Stavros S, Mavrogianni D, Kalantzis C, Loutradis D, Drakakis P. Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols. Arch Gynecol Obstet 2021; 304(2):547-57.
• 28. Datta AK, Maheshwari A, Felix N, Campbell S, Nargund G. Mild versus conventional ovarian stimulation for IVF in poor, normal and hyper-responders: a systematic review and meta-analysis. Hum Reprod Update 2021; 27(2):229-53.
• 29. Zhu L, Zhang Y, Liu Y, Zhang R, Wu Y, Huang Y, Liu F, Li M, Sun S, Xing L, Zhu Y, Chen Y, Xu L, Zhou L, Huang H, Zhang D. Maternal and Live-birth Outcomes of Pregnancies following Assisted Reproductive Technology: A Retrospective Cohort Study. Sci Rep 2016; 6:35141.
• 30. Luke B. Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies. Am J Obstet Gynecol 2017; 217(3):270-81.
• 31. Bu Z, Hu L, Su Y, Guo Y, Zhai J, Sun YP. Factors related to early spontaneous miscarriage during IVF/ICSI treatment: an analysis of 21,485 clinical pregnancies. Reprod Biomed Online 2020; 40(2):201-6.
• 32. Szeliga A, Calik-Ksepka A, Maciejewska-Jeske M, Grymowicz M, Smolarczyk K, Kostrzak A, Smolarczyk R, Rudnicka E, Meczekalski B. Autoimmune Diseases in Patients with Premature Ovarian Insufficiency-Our Current State of Knowledge. Int J Mol Sc. 2021;22(5).
• 33. La Marca A, Capuzzo M, Longo M, Imbrogno MG, Spedicato GA, Fiorentino F, et al. The number and rate of euploid blastocysts in women undergoing IVF/ICSI cycles are strongly dependent on ovarian reserve and female age. Hum Reprod 2022; 37(10):2392-401.
• 34. Bharti B, Lee SJ, Lindsay SP, Wingard DL, Jones KL, Lemus H, et al. Disease Severity and Pregnancy Outcomes in Women with Rheumatoid Arthritis: Results from the Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Project. J Rheumatol 2015; 42(8):1376-82.
• 35. Rahim MN, Long L, Penna L, Williamson C, Kametas NA, Nicolaides KH, et al. Pregnancy in Liver Transplantation. Liver Transpl 2020; 26(4):564-81.
• 36. Rahim MN, Theocharidou E, Yen Lau KG, Ahmed R, Marattukalam F, Long L, et al. Safety and efficacy of in vitro fertilisation in patients with chronic liver disease and liver transplantation recipients. J Hepatol 2021; 74(6):1407-15.