The effect of biological treatment on female fertility: A cohort study of women with rheumatoid arthritis and psoriatic arthritis

Objectives: To investigate female fertility in patients with rheumatoid arthritis (RA) exposed to biological drugs. Methods: In this retrospective cohort study, based on an electronic health record database, 4517 women with RA were compared to 1415 patients with psoriatic arthritis (PsA). Patients were 18-40 years-of-age at diagnosis. Biological treatments included tumor necrosis factor inhibitors, anti-CD-20 monoclonal antibodies, interleukin blockers and T-cell inhibitors. Main outcome measure was positive pregnancy test rate. Secondary outcome measures were pregnancy attempts and use of in vitro fertilization (IVF) Results: Mean age at diagnosis and at initiation of biological treatments was not statistically different between RA and PsA (30.7 f 6.3 vs. 30.9 f 6; p = 0.260 and 34.2 f 8 vs. 34.2 f 7.5 years; p = 0.729, respectively). Both groups demonstrated lower rates of positive beta hCG after diagnosis, as compared to baseline rates before diagnosis. However, exposure to biological treatment did not negatively affect the likelihood of conception in either group. Beta hCG testing increased in both groups after initiation of biological treatments (RA p <0.01, PsA p = 0.07). Use of fertility medications before diagnosis was about 8 % in both groups (p > 0.5). After diagnosis, before exposure, this percentage dropped to approximately 4 % in both groups (p > 0.5) but recovered to baseline values. Post-exposure IVF rate among RA patients was lower (p < 0.01) than the pretreatment state but was not significantly different in the PsA group. Conclusions: This large cohort study provides reassuring data regarding spontaneous and medicated fertility in patients exposed to biological medications. Further studies, as well as data on live birth rates are required to consolidate these findings.