young woman with painful hands due to arthritis

Association of Clinical Traits and Ovarian Reserve Decreases with Subfertility in Patients with Autoimmune Arthritis

Reproductive endocrinologist, Vinita Alexander, MD, coauthored this study to evaluate the relationship between autoimune arthritis patients such as those with rheumatoid arthritis and ovarian reserve. This study was presented at the American Society for Reproductive Medicine annual conference in Baltimore, Maryland, Tuesday, October 19, 2021

Often patients with autoimmune arthritis and other autoimmune diseases may fear that inflammatory processes and medications may decrease their fertility potential. In this retrospective study of patients with autoimmune arthritis, it was reassuring to find that high disease severity and high rates of ovarian reserve decrease were NOT associated with increased risk of subfertility or infertility.

Study Type

Prospective Observational


OBJECTIVE: Women with rheumatoid arthritis (RA) and Spondylarthritis (SA) have fewer children than healthy women,1,2 and women with RA have longer times to conception.1 This study aims to evaluate associations of ovarian reserve decreases and clinical traits with subfertility in autoimmune arthritis patients.

MATERIALS AND METHODS: This is a secondary analysis of a prospective cohort study.3 300 premenopausal women with a diagnosis of Juvenile Idiopathic Arthritis (JIA), RA, or SA submitted serum, sociodemographics, and medical history (including treatments, disease severity measures, and obstetric and fertility history). A subgroup of 95 arthritis patients reporting at least one live birth was identified, and it included fertile patients and those with subfertility (defined as answering yes to the question of ever trying to conceive for more than one year without getting pregnant). Serum Anti-mullerian hormone levels (AMH) were measured using Elecsys® AMH immunoassay at two time points up to 4.8 years apart. Patients in the original study were dichotomized according to annual decrease in AMH: >75th percentile and < 75th percentile (the referent group). The highest quartile included those with over 28% annual decrease in AMH concentration.

To study potential selection bias, fertile and subfertile arthritis patients were compared on clinical and disease characteristics using student’s t- and chi-square tests. Logistic regression was performed to explore the association of variables of interest with subfertility.

RESULTS: Among arthritis patients reporting a live birth, 71 (74.7%) patients were fertile and 24 (25.3%) were subfertile. Mean age was 36.6 and 36.4 years (P=0.87), and mean duration of disease was 7.9 and 9.7 years (P=0.36) for the fertile and subfertile patients, respectively. There were no significant differences between groups in terms of body mass index (BMI), arthritis drug regimens, number of joints involved in arthritis, or proportion with diminished ovarian reserve. For those with data, there was also no significant difference in the age at last pregnancy [85% of fertile (51/60) and 74% (14/19) of subfertile patients were < 34 years at last pregnancy, P = 0.27]. Among the 13 subfertile patients who reported a diagnosis for their subfertility, 30.8% (4/13) had an ovulation disorder and 30.8% (4/13) had unexplained infertility.

After controlling for BMI, age, and smoking history, risk of subfertility in the arthritis population was not associated with (1) disease severity (OR 0.98, 95% CI 0.62-1.56) or (2) the highest quartile of annual ovarian reserve decrease (OR 0.39, 95% CI: 0.13-1.21).

CONCLUSIONS: In these arthritis patients, there was no association between subfertility and disease severity or high rates of ovarian reserve decrease. Subfertile arthritis patients most often reported ovulation disorder or unexplained infertility as a cause of infertility.

IMPACT STATEMENT: High disease severity and high rates of ovarian reserve decrease do not increase odds of subfertility in the arthritis population. Other plausible factors contributing to subfertility in this population should be sought.


  • E’lysse A. Santana
    • Washington University School of Medicine in St. Louis
  • Vinita M. Alexander
    • MCRM Fertility and Washington University School of Medicine
  • Valerie Ratts
    • Washinton University School of Medicine