Undiagnosed Systemic Lupus Erythematosus in a Cohort of Infertile Women

Problem:  Systemic lupus erythematosous (SLE) is a chronic disease with a broad spectrum of clinical and immunological manifestations, therefore, this condition may be frequently misdiagnosed. The current study was conducted to determine the prevalence of undiagnosed SLE among a cohort of infertile women. Method of study:  Screening was performed using sequential (two stage) testing, which included a self-completed questionnaire followed by an antinuclear antibody (ANA) test. The Liang screening questionnaire was distributed to 143 consecutive infertile patients, aged 24–42 years (mean, 33.6 ± 4.7 years), who were receiving in-vitro fertilization (IVF) treatment. Patients who completed the questionnaire with three or more positive answers, were sent for ANA testing; those who tested positive (≥1:40) were referred to the Clinical Immunology Unit for anti-double-stranded DNA (dsDNA) antibody test and clinical assessment. Results:  A total of 136 women (95.1%) completed the questionnaire. Thirteen patients (9.6%) answered yes to three or more questions. Of these, five patients (3.7%) were ANA-positive and two (1.5%) had undiagnosed SLE. Conclusions:  A 1.5% prevalence of undiagnosed SLE was found in our cohort of infertile women. Additional investigations should be performed as to the role of SLE screening in infertile female population; a high-risk group with regard to ovulation induction treatments.