Musculoskeletal and Rheumatic Diseases as Emerging Risk Factors for Reduced Fertility

Abstract

The importance of musculoskeletal diseases (MSDs) and related immune mediated rheumatic conditions in both women and men is becoming more widely recognized, but underappreciated, as significant contributors to decreased fertility and adverse pregnancy outcomes. During assisted reproductive technology (ART) cycles, there is evidence accumulating from population-based registries, systematic reviews, and clinical cohort studies that indicate that individuals with various conditions like rheumatoid arthritis, systemic sclerosis, juvenile idiopathic arthritis, and others experience elevated rates of subfertility, childlessness, miscarriage, and complications. The biological mechanisms that directly affect gamete quality, implantation, and placental function include hormonal dysregulation, oxidative stress, chronic systemic inflammation, and direct effects. Significant knowledge gaps persist, particularly regarding male fertility and specific nonautoimmune MSDs, despite recent clinical guidelines advocating integrated reproductive health care for these patients. To address this overlooked aspect of health promotion, this editorial calls for a greater level of clinical awareness, regular preconception counseling, multidisciplinary collaboration between rheumatologists, orthopaedists, and reproductive specialists, and dedicated research funding.