<p class="first" id="d4078978e117">Systemic lupus erythematosus (SLE) is a chronic,
multiorgan, systemic autoimmune disease
that is more common in women than men and is typically diagnosed during reproductive
age, necessitating sex-specific considerations in care. In women there is no substantive
evidence to suggest that SLE reduces fertility, but subfertility may occur as a result
of active disease, immunosuppressive drugs, and age-related declines in fertility
related to delays in childbearing. Although pregnancy outcomes have improved, SLE
still poses risks in pregnancy that contribute to poorer maternal and fetal outcomes.
Cyclophosphamide, an important agent for the treatment of severe or life-threatening
lupus, may adversely affect fertility, particularly with increases in dose and patient
age. Fertility preservation techniques are therefore an important consideration for
women and men before cytotoxic treatment. There is mixed evidence as to whether exogenous
estrogen in the form of oral contraceptive pills or hormone replacement therapy may
increase the risk for the development of SLE, but among women with SLE already diagnosed,
combined oral contraceptive pills and hormone replacement therapy do not confer risk
for severe flare and remain important in reproductive care. The higher incidence of
SLE in women may nonetheless be attributable to effects of endogenous estrogen, as
well as failures in X chromosome inactivation, increased Toll-like receptor gene products,
and changes in microRNA function. A greater appreciation of the biological underpinnings
and consequences of sex differences in SLE may lead to more targeted treatments and
improved outcomes for patients with SLE.
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