The efficacy of assisted reproductive treatment in women with epilepsy

Abstract

Research question

The question of interest for this study was to examine the chance of a live birth following assisted reproductive technology (ART) treatment in women with epilepsy compared with women without epilepsy. In sub-analyses, the chance of biochemical and clinical pregnancies, and the impact of antiepileptic drugs (AED) treatment prior to embryo transfer, was analysed.

Design

This register-based cohort study was based on the Danish ART register comprising all women who underwent embryo transfer during 2006 to 2017, which included 730 ART treatments in 264 women with a history of epilepsy, and 128,387 ART treatments in 42,938 women without epilepsy. Adjustments were made for comorbidity, women's age, calendar year, type of infertility treatment and cause of infertility. A possible impact of AED use at the time of embryo transfer was studied in a sub-analysis. The primary outcome was live birth within a period of 140–308 days after the date of embryo transfer.

Results

The adjusted odds ratio for a live birth per embryo transfer in women with epilepsy, relative to women without epilepsy, was 1.06 (95% confidence interval [CI] 0.88–1.28). The adjusted odds ratio for a live birth among users of an AED was 1.22 (95% CI 0.77–1.92) relative to women who had stopped the use of AED prior to embryo transfer.

Conclusions

The chances of a live birth per embryo transfer were similar in women with and without epilepsy. These are novel and reassuring findings on the efficacy of infertility treatment in women with epilepsy.

Introduction

Women with epilepsy represent one of the most common chronic disease groups diagnosed during the childbearing years from age 20 to 45 years (Jolving et al., 2016). Birth rates among women with epilepsy are lower than in the general population (Farmen et al., 2016; Lofgren et al., 2009; Schupf and Ottman, 1994), although low birth rates do not translate directly into fertility or infertility. The direct relationship between epilepsy, medical therapies and infertility thus remains unclear. Birth rates or fecundity could be lower in women with epilepsy for several reasons, such as social factors, for example lower marriage rates or women considering not having children because of their epilepsy (Crawford and Hudson, 2003).

The question of interest for this study was the success of infertility treatment in women with epilepsy who cannot conceive naturally. Studies within the area of assisted reproductive technology (ART) treatment have indicated that ART treatment in women with chronic diseases such as chronic inflammatory bowel disease and rheumatoid arthritis is less effective than in infertile women in the general population (Friedman et al., 2017; Norgard et al., 2019). The mechanisms behind these results are as yet unknown, and a possible role of autoimmunity and/or inflammation has still to be examined. Some evidence has suggested a role of inflammation in the pathophysiology of epilepsy (de Vries et al., 2016), but in general epilepsy is not regarded as an autoimmune disease. The efficacy of ART treatment in women with epilepsy is yet to be studied.

This study aimed to examine the chance of a live birth following ART treatment in women with epilepsy who were seeking pregnancy, compared with women without epilepsy. The use of antiepileptic drugs (AED) might be associated with infertility in women with epilepsy trying to conceive (Pennell et al., 2018; Sukumaran et al., 2010; Thomas et al., 2013). In sub-analyses, the chance of biochemical and clinical pregnancies, and the impact of AED treatment prior to embryo transfer, was examined.