RISKS OF OVULATION-INDUCTION THERAPY IN SYSTEMIC LUPUS-ERYTHEMATOSUS

We report on four women with systemic lupus erythematosus who develope d two types of complications after ovulation-induction therapy for pri mary or secondary infertility. Primary infertility was associated with endometriosis in one patient. Three had previously known systemic lup us erythematosus. All had inactive disease at onset of ovulation-induc tion therapy. Three patients developed symptoms consistent with modera te lupus flare a few weeks after the onset of ovulation-induction ther apy. One patient developed inferior vena cava and unilateral left rena l vein thrombosis. No patient became pregnant. A high oestrogen level induced by ovulation-induction therapy may explain the occurrence of l upus flare in patients with prior inactive lupus. All our patients had prior asymptomatic antiphospholipid antibodies. One patient developed a major thrombotic event. The presence of antiphospholipid antibodies increases the thrombotic risk related to ovulation-induction therapy. We conclude that ovulation-induction therapy should be restricted to patients with long-standing inactive systemic lupus erythematosus. A p reventive increase of the corticosteroid dosage should be proposed in addition to heparin or antiaggregant therapy for those with prior asym ptomatic antiphospholipid antibodies, or with heparin therapy for thos e with prior antiphospholipid antibody-related events.