title: Fertility and infertility in rheumatoid arthritis.
abstract: OBJECTIVE
  Despite decades of evidence suggesting that women with rheumatoid arthritis (RA) have fewer children than their healthy peers, this information is not widely known among clinicians. The causes of decreased fertility in this population have been largely unexplored, but likely revolve around altered inflammation, increased age when conception is attempted, limited sexual function, and possibly medications limiting ovarian function.
  
  
  RESULTS
  Several large Scandinavian cohorts and a cohort study in the United States demonstrate that women with RA have smaller families and are slower to conceive compared with other women. Personal choice to limit family size plays some role, as does infertility. Sexual function in women with RA is hampered by pain and fatigue, perhaps decreasing the opportunity for conception. Finally, data about the role of NSAIDs in preventing ovulation suggest that continued use of these medications may hinder conception.
  
  
  CONCLUSIONS
  Infertility in women with RA is an under-recognized, but remarkably common phenomenon. Although research continues into the underlying causes, physicians can discuss this topic and refer women to reproductive endocrinology when needed, thereby helping patients to build the families that they desire.
authors.affiliation: aDivision of Reproductive Endocrinology and Fertility, Department of Obstetrics and Gynecology bDivision of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Provost
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Eaton
authors.forename: Megan E B
authors.initials: ME
authors.lastname: Clowse
mesh_terms: D000375:Aging / Q000502:physiology; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology; D002755:Choice Behavior; D005260:Female; D005298:Fertility / Q000502:physiology*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D011247:Pregnancy; D012725:Sexual Behavior
chemical_list: D018501:Antirheumatic Agents