Outcomes of assisted reproductive technology in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis

Data on patients with immune-mediated rheumatic diseases (IMRDs) undergoing assisted reproductive technology (ART) remain limited. We searched PubMed, Scopus, Cochrane Library, and Google Scholar up to 22/11/2025, for cohort or case-control studies comparing ART outcomes between women with IMRDs and controls, or case series of women with IMRDs undergoing ART. Our primary outcomes were live birth (per cycle, per embryo transfer (ΕΤ), and per couple) and miscarriage. We pooled odds ratios (ORs), mean differences (MDs), and Freeman-Tukey transformed proportion estimates using random-effects models. Twelve studies were included, covering Sjögren's disease (SjD), undifferentiated connective tissue disease (UCTD), systemic lupus erythematosus and/or antiphospholipid syndrome (SLE/APS), rheumatoid arthritis (RA), and familial Mediterranean fever (FMF). Live birth per ET was significantly lower in SjD (OR 0.49 (95 % CI 0.26-0.91)) and RA (OR 0.71 (95 % CI 0.61 - 0.83)). Live birth rates per couple were lower in all diseases. We found significant reductions in live birth rates per cycle, ET, and couple in the overall IMRD analysis. The pooled live birth rates per ET were 24 % in SjD, 24 % in SLE/APS, 18 % in RA, 38 % in FMF, and 26 % in the overall IMRD analysis. Very low to low-certainty evidence showed lower live birth rates per ET in SjD and RA and lower live birth rates per couple in all diseases. Effect sizes may have been influenced by confounding. More large-scale, high-quality data and consistent documentation of baseline characteristics and treatment regimens are needed to draw reliable conclusions regarding the effect of IMRDs on ART outcomes.