The ART of Rheumatology: Patient Perceptions and Utilization of Fertility Care in Rheumatic Disease

Background: Patients with autoimmune rheumatic diseases (ARDs) have fewer biological children than those without ARD. Therefore, these patients may benefit from evaluation by fertility specialists and utilization of assisted reproductive technologies (ARTs). This study evaluated individuals with ARD’s perceptions of fertility care, ART utilization, and barriers to use. Methods: An anonymous online survey was distributed through social media, email, and patient portals. The inclusion criteria included having a diagnosed ARD and seeing a specialist for this within the past year. The survey evaluated perceptions of how ARD and medications affect fertility, as well as participants’ knowledge and understanding of the safety and efficacy of ART in these conditions. Descriptive and comparative statistics were used to summarize the responses and compare demographics. Results: In total, 1060 participants met the criteria for participation in the survey, with 32% reporting a history of infertility. 92% had heard of ART, but many were unsure of its safety (60%) or success (42%) in patients with ARD. Of participants reporting a history of infertility, only 50% utilized ART, citing cost/lack of insurance coverage as the most common reason this was not pursued. Access to ART and barriers varied by demographics, with marginalized groups less likely to receive this care. Conclusion: ART is underutilized by patients with ARD and infertility due to several barriers. Misconceptions and the lack of knowledge about ARD and fertility care warrant special attention by clinicians to ensure that educational gaps are addressed and patients are promptly referred to fertility specialists.