Wednesday, April 22, 2009 Annette asks

Q: Infertility treatments and rheumatoid arthritis -- others who have had repeated failed attempts?

A little over three years ago, we decided to try and start a family. In order to do so, I had to start coming off my RA drugs (methotrexate), but have continued taking 50mgs of Enbrel weekly and 10 mgs Prednisone daily. Now three years into trying, we have decided to work with a fertility specialist. Over the last two years, we have undergone 4 IUI attempts (one was a converted IVF attempt) and one recent failed IVF attempt. I have never been pregnant during the last three years. I am 42 years old which is a a contributing factor, but I can't help but question whether something else is happening which may be related to my RA drugs. I have been labeled an "intermediate responder" to the IVF protocol which is good and my husband's results are strong. On paper, no reason why we shouldn't be getting pregnant. And my rheumatologist and fertility specialist say no issues with the current drugs, but I'm not convinced. If pregnant, the plan would be to discontinue the use of Enbrel, but not until we're pregnant. Studies have shown that it's safe and some women have remained on Enbrel during their pregnancy. We're not taking the chance since there isn't enough data yet.

I noted a post about changing prednisone to sulfasalazine, but wanted to see if anyone else has been working with a fertility specialist, is in a similar position and has modified their protocol resulting in a successful pregnancy?

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Answers (2)

Lene Andersen, Health Guide

4/27/09 11:33am

If your doctors feel that it is safe for you to be on Enbrel while trying to conceive, it is likely that they are right. I don't know much about being immunosuppressed and trying to conceive, but I'm sure that your fertility doctor is up on the latest research on that, so I don't think you have to be too concerned. In addition, based on the research (limited and in Google) I have done, it appears that prednisone is often used safely by women with RA while trying to conceive and while being pregnant. However, it is my understanding that prednisone may interfere with your ovulation, not the actual conception, but given that you're on IVF, that is less of a problem.

Obviously, I'm not a fertility expert, so I'm not going to say too much about this, but I have known a number of women who have used fertility treatments and some were like you, no identifiable problem on paper, but they had great trouble getting pregnant and from what I could see from their experience, IVF can be a bit of a crapshoot. Sometimes it takes and often it doesn't. As you mention, your age may also be a factor, but I don't know how much. I would suggest that if you haven't already, you sit down with your fertility doctor and have an in-depth chat about drugs, RA and how they may interact.

I know this is a hard thing to go through and they break your heart every time you don't get pregnant. I hope you and your child find each other, whether it's through carrying it yourself or adoption (if that's an option for you).

mkmac4

4/23/09 3:22pm

Since Enbrel attacks the immune system, it may be keeping you from becoming pregnant. Not a good idea either to get pregnant while on Prednisone. It's a steroid which can affect your fertility. I think you are going to have to make a choice of going off all the drugs to become pregnant and then go back on them after the baby is delivered or the decision to discontinue the process of becoming pregnant. Not an easy choice for you.

Q: Infertility treatments and rheumatoid arthritis -- others who have had repeated failed attempts?

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