Key message
Women with epilepsy can expect the same success of a live birth per embryo transfer as other women receiving infertility treatment. The use of antiepileptic drugs in women with epilepsy should
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.
Based on Danish health registries, this nationwide cohort study comprised all embryo transfers in Denmark from 2006 to 2017, including follow-up on child births until December 2018. Data were obtained as follows: (i) data on ART procedures, causes of infertility and pregnancy from the Danish ART Registry (Andersen et al., 1999; Westergaard et al., 2000); (ii) data on outcome of infertility treatment (live birth) from the Danish Medical Birth Registry (DMBR) (Bliddal et al., 2018); (iii)
A total of 730 ART treatments in 264 women with a history of epilepsy were included in the exposed cohort, and 128,387 ART treatments in 42,938 women without a history of epilepsy in the unexposed cohort (Table 1). The type of preceding treatment was clinically similar in the two cohorts, although P-values were low for male/female factor infertility, BMI, smoking status and alcohol consumption, year of treatment, parity and comorbid diseases due to the large study cohort. In the exposed cohort,
The chances of a live birth per embryo transfer were similar in the women with or without epilepsy. These are novel and reassuring findings on the efficacy of infertility treatment in women with epilepsy. Physicians can expect to treat and counsel an increasing number of women with epilepsy, and therefore also need evidence when counselling on reproductive questions and the efficacy of ART treatment. Several aspects are relevant regarding the success of ART for women with epilepsy. First, the
The authors thank Cecilie Johannessen Landmark, Department of Life Sciences and Health, OlsoMet, Oslo, Norway, for assistance and discussions of methods. The study was supported by the Research Foundation of the Region of Southern Denmark, and the Free Research Foundation at Odense University Hospital, Denmark.
Michael Due Larsen is Associate Professor in Clinical Epidemiology at the Institute for Clinical and Molecular Medicine at the Norwegian University of Science and Technology, Norway. He is affiliated to the Centre for Clinical Epidemiology at Odense University Hospital, Denmark. Key message Women with epilepsy can expect the same success of a live birth per embryo transfer as other women receiving infertility treatment. The use of antiepileptic drugs in women with epilepsy should
Michael Due Larsen is Associate Professor in Clinical Epidemiology at the Institute for Clinical and Molecular Medicine at the Norwegian University of Science and Technology, Norway. He is affiliated to the Centre for Clinical Epidemiology at Odense University Hospital, Denmark. Key message Women with epilepsy can expect the same success of a live birth per embryo transfer as other women receiving infertility treatment. The use of antiepileptic drugs in women with epilepsy should follow the same clinical guidelines as for other women with epilepsy contemplating pregnancy.