ACR 2022 Reproductive Issues
Credit: Tatiana Ayazo

Key Takeaways 

  • 60% of people with a rheumatic disease think that the disease affects fertility.
  • Most have heard about assisted reproductive technology (ART) but are unsure if it the fertility treatment is safe.
  • ART is usually (but not always) safe for people with rheumatic diseases. 
  • Tell your rheumatologist if you’re thinking of getting pregnant, or seek out a fertility evaluation if you’ve been trying to conceive for at least six months.

People with rheumatic diseases can — and often do — have children. But if you live with a chronic disease like rheumatoid arthritis (RA) or psoriatic arthritis (PsA), you might end up having some trouble conceiving. That’s not always the case, but the chronic inflammation that goes along with these conditions sometimes causes fertility issues. Women with rheumatic diseases are also more apt to have endometriosis and polycystic ovary syndrome (PCOS), and these health problems interfere with fertility.

In some instances, assisted reproductive technology (ART) such as in-vitro fertilization (IVF) is the easiest or only way to have a child. You might also benefit from ART if you’re a woman with a rheumatic disease but your male partner has a problem with their sperm, or if you’re a woman trying to start a family with a same-sex partner.   

The catch: Many people with rheumatic diseases aren’t sure if ART is an option for them. 

That’s the main finding of a new study, presented at the annual meeting of the American College of Rheumatology 2022 (ACR Convergence) in Philadelphia. The study was conducted by a team of researchers, including CreakyJoint’s parent organization, the Global Healthy Living Foundation.   

About the Study

People with rheumatic diseases tend to have fewer biological children compared to the general population; the study authors wanted to learn about whether lack of knowledge about ART might be an important barrier. They surveyed 835 rheumatic disease patients, most of whom were female (90 percent).

According to the researchers, 60 percent of respondents believed that their rheumatic condition might have hindered their fertility, which could very well be true. (Every patient is different, and not everyone with a rheumatic disease has fertility problems.)  

As for ART, the overwhelming majority of respondents — 92 percent —had heard of it, but 60 percent said that they weren’t sure whether it was safe for people with rheumatic diseases.

In reality, ART is usually safe for people with rheumatic disease, though each patient needs to be independently evaluated and assessed, says study co-author Cuoghi Edens, MD, a rheumatologist and Assistant Professor at the University of Chicago Medicine.  

“Studies have not shown increased complications in those with rheumatic diseases, except for those who have increased risk of blood clots” as a result of their specific condition, she explains. Those prone to blood clots often have lupus or antiphospholipid antibodies.” 

Edens notes that ART may be slightly less effective in people with rheumatic diseases compared to the general population, though it’s not yet clear why. Yet for many, it is the key to starting or expanding a family.  

What This Means for You

Anyone with a rheumatic disease should talk to their rheumatologist before trying to get pregnant, says Edens. Whether you end up conceiving naturally or struggle and decide to try ART, planning ahead is extremely important. 

“We know that planned pregnancies in rheumatic diseases are best. They allow for conception at the best time for the patient on medications that are compatible with pregnancy and with their disease under good control or even in remission,” she Edens. “Unfortunately, some of the best medications in rheumatology – such as methotrexate – are not safe for pregnancy, so it’s important to have these discussions early to avoid a miscarriage caused by unsafe medication or having a baby with birth defects.”

She also advises against waiting too long to seek help if you’re having trouble. If you or your partner has a rheumatic disease and you haven’t conceived naturally after six months of trying, it’s time to get evaluated for possible causes of infertility.

“This initially involves bloodwork, an exam, and ultrasound for a woman and a sperm analysis for a man. This can often be done by a primary care provider, gynecologist, midwife, or other women’s health care provider,” says Edens.

Such an evaluation doesn’t necessarily mean you’ll be a candidate for ART or that you’ll want to use it. You might simply need treatment for a previously undiagnosed problem such as PCOS.  

“Nothing upsets me more than when I meet a patient and they tell me, ‘We have been trying to get pregnant for two years. My provider told me to just keep trying,’” she says. “Infertility affects one in eight couples, and diagnosing it is key to the next steps.” 

Be Part of Research with ArthritisPower

Join CreakyJoints’ patient-centered research registry and participate in voluntary studies about managing arthritis. Learn more and sign up here.

Peninger E, et al. Fertility and the Use of Assisted Reproductive Technologies: Perceptions, Thoughts and Experiences of Men and Women with Rheumatic Disease [abstract]. Arthritis & Rheumatology. November 2022.  

Interview with Cuoghi Edens, MD, a rheumatologist and Assistant Professor at the University of Chicago Medicine. 

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