I'm getting really anxious and would LOVE advice from anyone who has had a successful pregnancy with moderate to severe RA. I've just turned 36, was diagnosed with RA about 2 years ago and have been TTC for over a year. I was previously on a low level drug regime (sulfuzalizine, predinsone) and resistant to taking methotrexate (MTX) as I wanted a baby badly and didn't want to have to wait (also I was worried about the side effects). I have felt sort of okay on that regime but my blood tests have consistently showed high levels of inflammation and I do get very stiff in the mornings. I even tried Enbrel and that didin't help much. Since it's now been over a year TTC with no luck my rheumatologist has encouraged me to take MTX for a little while to get my bloods under control and to then TTC.
My questions are:
Do you think it is possible that high inflammation has made it hard to conceive (not sure if at my age I should forget about MTX and just keep TTC)?
How long does MTX take to work? Does it work quicker if you take a higher dose (my dr suggested 20mg per week?)
Does it work quicker if you’re also on a biologic like Enbrel?
How long do you need to stop taking MTX before TTC?
Has anyone had the experience that Enbrel works really well initially (the first day after I took it I didn't need any other drugs) and then it stopped working (now after taking it for 6 weeks I feel the same as before I started)
Anything else I need to consider?
THANK YOU!!
Thanks to everyone for your (very quick) responses. I understand it’s a difficult question and it’s really targeted at people who’ve had successful pregnancies with RA. Anyone with moderate-severe RA would have had some experience with drugs and would likely have views/tips on this. I’ve seen a fertility specialist and he had no idea. I don’t think there are many fertility specialists with knowledge of RA drugs (and vice versa rheumatologists with fertility knowledge). It’s not something someone without RA (or a similar condition) can really understand but people with it who TTC are likely to be able to offer something. Thanks.
Thanks f
Nothing yet! I just wanted to say a huge THANK YOU to those people who have posted useful, on topic, supportive messages and/or informed opinions based on their experience. I really, really appreciate it and have already looked into some of the things that were suggested. It warms my heart that you would go out of your way to be helpful and supportive to a stranger and from the way some comments were written I can tell that you tried to walk a mile in my shoes before commenting. Which is just what people on this site need. Thank you.
I feel for you, but I would be so scared of repercussions to my baby from drug interactions.
Research this thoroughly before you decide to conceive.
I would go off all the drugs (I am not an expert) and would start regular acupuncture treatments at a community acupuncture center (treatments usually run 20 bucks) to manage the RA. You can also get fertility boosts during each treatment.
I feel that pregnancy can actually "restart" your system and work for your body. So perhaps a win-win...I am always the optimist!
One year is really not that long in the scheme of trying to conceive. It took 5 years for our first and then another 7 for our second. I am now 38.
I know that desire of TTC and it doesn't just "go away"...Try different things, don't give up. Don't try to predict the future. Believe in miracles. I have a friend who conceived after 4 fertility docs told her it was impossible. (She had had cancer and had gone through "menopause" due to the chemo) She has two children now.
Good Luck to you!
Oh and yes...you can cope with the rigors of motherhood. Women are strong and you can do it. And you will. Loving each challenging moment every step of the way.
My brothers wife just gave birth to her son 6 months ago and she has RA. He was a surprise baby because they hadnt really been tryin. But once she found out her and the drs took her off MTX. She was in a lot of pain during the pregnacy because she didn't want to take the harsh meds,'and tried to deal wih it by using Tylenol. But her son is completely fine. And once she had him she was able to fo back on her meds. She has days where its tough to hold him but my brother is awesome and helps. Which i think is he key! I know what you are going through However, i see how hard it is on my SIL and my mom has it pretty sever.'she is having surgery next week to straighten her foot and fuse the joints. She had the other foot done already as well as a few fingers. And I am having my RA factor ran again because my dr said with how bad she is I will most likely have it, and I think I'm showing signs already. Sorry I don't have specifics on my SIL meds but i wanted to give you hope and know it can be done!
I completely understand what you are going through! I don't have RA, but do have an autoimmune that is similar and is treated with some of the same meds. I was diagnosed at 39, a few months after deciding to do IVF. I will tell you it is possible to have a healthy pregnancy, though success correlates with disease activity...at least in my condition (polymyositis).
In my experience, my fertility and OB doctors deterred all things related to disease to my rheumatologist, and vice versa. Neither wanted to make decisions related to the other's field of practice. Where you will find some answers, is a Maternal Fetal Medicine doctor (high risk OB doctor). Research and ask around you....try to find one that specializes in autoimmune conditions....not totally important but you can try. This is the doctor that can give you all the info on the medicines you can and cannot take before and/or during pregnancy, and how long you need to be off it before conceiving.
I also resisted all meds other than prednisone. Methotrexate is an absolute no....though you are still young...and if thats what will get the disease under control then maybe think about it. It can take a few months for it to start working I believe, and then I think it's at least 6 months (confirm this with a doctor) that you need to be off it before conceiving...so thats already a long time, I know...add the time to take it and kick the disease...you are at least 1 year and probably more.....and it's scary I know!! I was also told I couldn't be on biological drugs either...but mine is rituxan not enbral so maybe different?
I had tapered down and was on 12.5mg prednisone throughout and had no problems. my disease was in remission.
Sorry you are going through this- but don't give up! Get yourself healthy and then get pregnant :). I am hear to tell you it's possible!!
Email me if you have more questions!
Good luck!!
Don't take methotrexate. It is the same drug they use in chemical abortions. It will basically chemically abort any child you attempt to conceive and in the event that you do manage to carry a child to term, you are close to 100% likely to have a child with severe birth defects. Unfortunately, methotrexate lingers in your system for so long that you can never fully be sure that you will not have a child with severe disabilities. I can't believe any reputable fertility specialist wouldn't advise you against that. Plus your Rheumatologist should ask you about your plans to conceive before they advise you on any drug combinations.
I'm not sure what Reproductive Specialist you have consulted, but try Dr. Najmabadi in Beverly Hills. I have moderate RA and was advised that I should start Humera or Enbrel along with MTX to attempt to slow the process of joint damage. As soon as I told my dr. that I wanted to try and get pregnant, she said we have to wait on the drugs. Dr. Naj said the same thing. I did conceive through Dr. Naj on the first try, unfortunately I miscarried at 10 weeks. But I would recommend giving him a call!
Good luck to you!
cma
I would truly talk to a fetility doc about this. They are the experts or a pregnancy specialist. Someone who specializes in difficult pregnancies. My friend has been trying for years too. She did get pregnant then had a miscarriage.
Moms have gotten pregnant with RA before. They may not have known they had it, they might have not been on any meds. The only thing I can think of is that a doc who knows what the effects are may be able to give you better information and knows what the tests results mean to a fetus.
I do not have experience with RA, but I do have a lot of experience with difficult pregnancies. I was on full bedrest for three months with my last pregnancy and I spent a lot of time on babycenter.com. They have several support groups for women with very specific health issues. I am sure they would have one for RA. I found it very comforting to talk to other women going through the same issues that I was going through. Good luck with everything.
I don't have experience with RA but I do have experience with the methotrexate shot. I had to take it to dissolve an ecptopic pregnancy. The one big thing about that is that it totally depletes you of folic acid, which is really important when you want to get pregnant as it prevents birth defects and helps in brain development. My OB told me to wait at least 6 months before trying again, I've also heard to wait up to a year. So that's something you want to get some more info on, sometimes the pharmacist is good for these kind of things too. Wishing you luck!
I think Martymomma is completely wrong. Do you realize how many people have arthritis, how many diseases are genetic and you run the possibility of passing on even if you don't have symptoms. It;s a managable disease. I ahve arthrtitis and would never question having a kid because of passing it down. I;m sure cancer, or arthritis, or something bad runs in all of our families...we're not trying to create some perfect baby...That baby will live a healthy life until adulthood and then IF the kid has RA there are ways to manage it...and in 20 years they may have a cure
It's diferent if you pass down a genetic mutation that will alter the babies life from birth on and never allow for a happy life but plenty of people have arthritis and live healthy lives
These questions are above any of our knowledge, I'm afraid. I really think a fertility specialist could be very helpful or you. My sister had incredible difficulty in getting pregnant in her twenties. She saw a fertility specialist and it really changed the tide for her.
Are you on Facebook? If so 'Like' Autoimmune, Paleo, and You'. Ive read MANY stories throughout the Paleo community of women who became fertile after going Paleo. So, you could get MUCH relief (probably remission), AND concieve. Pretty awesome if you ask me. At least look into it...
Best Wishes
