Fertility Disorders in Women with Rheumatoid Arthritis: Proportion and Associated Factors

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Published Oct 11, 2026
https://doi.org/10.62438/tunismed.v104i09.6904
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Vol. 104 No. 09 (2026): Tunis Med Sept 2026

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Leila Rouached
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Sarra Mahjoub
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Meriem Garci
Gynecology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Siwar Ben Dhia
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Selma Bouden
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Ines Mahmoud
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Rawdha Tekaya
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Cyrine Belgith
Gynecology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Aicha Ben Tekaya
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Nabil Mathlouthi
Gynecology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
Leila Abdelmoula
Rheumatology department, Charles Nicolle Hospital, Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

Abstract

Objective: To determine the proportion of fertility disorders in non-menopausal women with rheumatoid arthritis (RA) and to identify associated factors.
Methods: We conducted a cross-sectional observational study including non-menopausal women aged ≥18 years diagnosed with RA. Sociodemographic characteristics, disease-related variables, and treatments were collected. Prolonged time to conception was defined as a time
to conception exceeding 12 months. Infertility was defined as the absence of pregnancy after 12 months of unprotected and regular intercourse.
Results: Fifty women were included (mean age: 39.1 ± 6.9 years). The mean age at RA diagnosis was 31.1 ± 8.7 years, with a median disease duration of 8.5 years. RA was immunopositive in 27%, and erosive in 80%. Extra-articular manifestations were observed in 34% of patients, predominantly sicca symptoms (28%). Fertility disorders were identified in 31% of patients: 10% had a prolonged time to conception and 21% had infertility, which was primary in 80% of cases. Pregnancy loss occurred in 48% of women with prior pregnancies. Receiver operating characteristic (ROC) analysis indicated that RA duration >6 years was significantly associated with fertility disorders (AUC =0.692, p = 0.049), with a sensitivity of 84.2% and specificity of 55.2%. No significant associations were observed between fertility disorders and disease activity or current treatments.
Conclusion: Fertility disorders are common in women with RA. Disease duration exceeding six years emerged as a significant associated factor. Early disease control and systematic reproductive counseling should be integral components of RA management in women of childbearing age.

Keywords:

Rheumatoid arthritis, autoimmune disease, infertility, fertility disorders, women’s health

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